Documente Academic
Documente Profesional
Documente Cultură
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:
CVV:
I authorize NYS DSCC to charge the credit card provided on this form for the amount indicated below.
SIGNATURE:
AMOUNT: