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Oysters with Obenshain

http://www.markobenshain.com

~ Spring Seafood Social ~

TO SUPPORT

SENATOR MARK OBENSHAIN

Thursday, April 25, 2013
Rockingham County Fairgrounds
4808 S. Valley Pike, Harrisonburg
Seafood Social - 4:30 pm

RSVP by April 20th
Contribute online (below) to
RSVP or call (804) 482-0574 or
email rsvp@markobenshain.com

Personal Information

First NameRequired
Last NameRequired
EmailRequired
Home AddressRequired
Home Address (line 2)
CityRequired
StateRequired
Zip/PostalRequired
Phone NumberRequired

Employment Information

EmployerRequired
OccupationRequired

Contribution Amount

$5,000 - Grand Benefactor (8 VIP Tickets)
$2,500 - Benefactor (6 VIP Tickets)
$1,000 - Patron (4 VIP Tickets)
$500 - Sponsor
$250 - Friend
$60 - Individual

Guests:

Payment Information

Debit/Credit Card

Card Number
CSC ?
Expiration

Routing Number
Account Number

Billing Information

Same as home address.
Billing Address
Billing Address (line 2)
City
State
Zip/Postal

Legal Compliance

I affirm that the following statements are true and accurate:

Paid for and authorized by Obenshain for Attorney General

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Contributions to Obenshain for Attorney General are not tax deductible as charitable gifts for income tax purposes. State law requires we report the name, address, occupation, and employer for each individual whose contributions aggregate in excess of $100 per calendar year.

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