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Please join

Senator Andrea Stewart-Cousins


Democratic Conference Leader
&

Senator Michael Gianaris


DSCC Chair
with Special Guest

Governor Andrew M. Cuomo


at the

New York Senate Dems


GOTV Reception
Tuesday, October 25, 2016
6:00PM Chairs Reception - 6:30PM General Reception
Kimpton Hotel Eventi
851 Avenue of the Americas
Manhattan
For more information or to RSVP, please contact Evan Rantzaklis by
phone at (518) 462-2867 or email at erantzaklis@newyorksenatedems.com.

Contribution Form
____ YES! I/we will attend the GOTV Reception on October 25th!
$25,000 (includes admission to special Chairs Reception with Governor Cuomo)
$10,000 Sponsor $5,000 Supporter
$1,000 Guest
Please check box to indicate that this is a HOUSEKEEPING contribution.
____ Unfortunately, I/we will not be able to attend, but please accept my/our contribution of $ __________.
For compliance with New York State Election law and campaign guidelines, please complete the following:
ORGANIZATION:

CONTRIBUTION
TYPE (PLEASE
SELECT ONE):

NAME:
ADDRESS:

PHONE:

CITY:

FAX:

STATE:

ZIP CODE:

INDIVIDUAL
PARTNERSHIP
CORPORATION
PAC/LLC

E-MAIL:

CREDIT CARD#:

PAYMENT TYPE:

NAME ON CARD:

EXP DATE:

AMEX MASTERCARD VISA

CVV:

I authorize NYS DSCC to charge the credit card provided on this form for the amount indicated below.
SIGNATURE:

AMOUNT:

Please make checks payable to:


New York State Democratic Senate Campaign Committee (NYS DSCC)
111 Washington Ave, Suite 409
Albany, NY 12210
You can fax credit card contributions to (518) 462-1082.
Individuals, PACs and LLCs may contribute $109,600 per calendar year. Partnerships may also contribute $109,600 per calendar year, though contributions above $2,500
must be allocated to specific partner(s) and not exceed the individual maximum. Corporations may contribute in the aggregate up to $5,000 per calendar year in New
York State. New York State Election law permits unlimited donations to the DSCC Housekeeping Account. Political contributions are not tax deductible. Paid for by the
New York State Democratic Senate Campaign Committee and not authorized by any candidate or candidates committee. Designed IN-HOUSE by Jonaliza.com.

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