If you plan to attend please EMAIL ME DIRECTLY.
Greenwich Secrets....
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Ned Lamontinvites you to join him at a cocktail reception for
Greenwich First Selectman Candidate
John Blankley
Tuesday, October 11th, 2011
6:00pm to 8:00 p.m.
Hosted by:
Alonso Martinez and Claudette Rothman
54 Hillcrest Park Road
Old Greenwich, CT 06870
Suggested contribution $250
RSVP: Christopher Smith at(516) 445-3715 or csdcstrategies@gmail.com
Contribution form is below
===========================
Yes, I/we will attend the October 11th reception. Enclosed is my/our contribution of:
___ $250
___ $_____________ (other amount)
I cannot attend the reception, but I have enclosed my contribution of:
___ $250
___ $_____________ (other amount)
FOR CREDIT CARD CONTRIBUTIONS PLEASE VISIT WWW.BLANKLEYFORFIRSTSELECTMAN.COM
Individual Contributor Certification Form
Blankley for First Selectman
C/O Michael Sandifer
340 Riversville Road
Greenwich, CT 06831
NAME OF INDIVIDUAL CONTRIBUTOR:_________________________________________
CONTRIBUTION AMOUNT:_____________________________________________________
EMAIL:________________________________________________________________________RESIDENTIAL ADDRESS:_______________________________________________________
CITY:________________ STATE:_________ ZIP CODE:__________ PHONE:____________
Are you 18 or older? ____ Yes _____ No If you are not 18 or older, please list your age: _____
EMPLOYER:___________________________________________________________________
PRINCIPAL OCCUPATION:______________________________________________________
Please answer each of the following:
Yes ______ No _______ Are you a lobbyist?
Yes ______ No _______ Are you the spouse or dependent child of a lobbyist?
Yes ______ No _______ Do you or a business with which you are associated have a contract with the Town of Greenwich that is valued at more than five thousand dollars?
CERTIFICATION:
I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief.
I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States.
I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.
_____________________________________________ __________________________
SIGNATURE OF CONTRIBUTOR DATE
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