You are cordially invited to a

Reception
With Republican Presidential Candidate

Newt Gingrich
Monday, March 19th 7:00pm 8:00pm The Home of Norman R. Gordon 5500 Keithville-Springridge Road Shreveport, Louisiana $250 per person
R SV P to A shley Fischer: afischer@newt.org, phone: (615)642-0702

Contributions to Newt 2012 are not tax deductible for federal income tax purposes. The maximum an individual may contribute to Newt 2012 is $2,500 for the primary election and an additional $2,500 for the general election. Couples may contribute up to $5,000 for each election; joint contributions require the signature of both spouses. Federal multicandidate PACs may contribute up to $5,000 for each election. By submitting your contribution, you agree that the first $2,500 of a contribution will be designated for the 2012 election, and any additional amount, up to $2,500 will be designated for the 2012 general election. Contributions from corporations, foreign nationals, and federal government contractors are prohibited. Contributions must be made from personal funds and may not be reimbursed by any other person. Federal law requires us to use our best efforts to obtain and report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle

Paid for by Newt 2012

 Please reserve ______ ticket(s) at $250/person to attend the Reception with Newt Gingrich

Enclosed is my contribution by personal check (payable to Newt 2012) I will contribute online at www.newt.org No, I am unable to attend the event but would like to support Newt Gingrich for President. Enclosed is a contribution of $100 $250 $500 $1,000 $2,500 or $__________________. I will contribute online at www.newt.org
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Please mail or fax this completed form (or address inquiries) to:
Newt 2012 Post Office Box 550769 Atlanta, Georgia 30355 (678) 973-2236 phone (678) 732-3314 fax ALL CONTRIBUTORS MUST COMPLETE THE FOLLOWING INFORMATION. WE ARE REQUIRED TO REPORT THE NAME, ADDRESS, OCCUPATION AND EMPLOYER OF ALL CONTRIBUTORS*, AND THE OTHER CONTACT INFORMATION IS NECESSARY FOR US TO REACH YOU. ___________________________________________ Full Name _________________________________________________
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________________________________________________ ID CODE:____________________ E-Mail Contributions to Newt 2012 are not tax deductible for federal income tax purposes. The maximum an individual may contribute to Newt 2012 is $2,500 for the primary election and an additional $2,500 for the general election. Couples may contribute up to $5,000 for each election; joint contributions require the signature of both spouses. Federal multicandidate PACs may contribute up to $5,000 for each election. By submitting your contribution, you agree that the first $2,500 of a contribution will be designated for the 2012 election, and any additional amount, up to $2,500 will be designated for the 2012 general election. Contributions from corporations, foreign nationals, and federal government contractors are prohibited. Contributions must be made from personal funds and may not be reimbursed by any other person. Federal law requires us to use our best efforts to obtain and report the name, mailing address, occupation, and name of employer for each individual who sec ontributions aggregate in excess of $200 in an election cycle.

Paid for by Newt 2012