Please Join

House Majority Leader Steny H. Hoyer

and Senator Charles E. Schumer

for an evening reception in support of

Senator Kirsten Gillibrand


Thursday, March 26
th

6:30 p.m. 8:00 p.m.

315 C Street, NE
Washington, DC


Host - $5,000 per PAC / $4,800 per individual
Sponsor - $2,500 per PAC / $2,400 per individual
Patron - $1,000 per PAC / $500 per individual

For more information or to RSVP, please contact
events@kirstengillibrand.com or 202-270-4991 by March 24
th


To learn more about Kirsten, visit http://kirstengillibrand.com/

Contributions or gifts to Gillibrand for Senate are not deductible for federal income tax purposes. Contributions from
corporations, labor organizations treasury funds and foreign nationals are prohibited.

Paid for by Gillibrand for Senate
Reception with House Majority Leader Steny H. Hoyer, Senator Charles E. Schumer
and Senator Kirsten Gillibrand
Thursday, March 26, 2009

_____ Yes! I/We would like to attend at the following level:

Co-Host: $5,000 per PAC or $4,800 per person
Sponsor: $2,500 per PAC or $2,400 per person
Patron: $1,000 per PAC or person

_____ Unfortunately, I cannot attend but I would like to make a contribution in the amount of $ .

To contribute by PERSONAL check, please make your contribution payable to Gillibrand for Senate. To contribute by PERSONAL
credit card, please provide the information below:

Please charge $ to my personal, not corporate, credit card: Visa / Mastercard / AMEX

Name of Cardholder:

Credit Card #: Exp. Date:

Please fax credit card contributions to (866) 681-6746
Please mail checks to: Stefanie Conahan, Gillibrand for Senate, 1415 North Taft Street, Suite 477, Arlington, VA 22201

Please sign below: I designate my contribution(s) to Gillibrand for Senate, as follows, the first $2,400 for the 2010 Senate primary election, and
any additional amount that I contribute up to $2,400 for the 2010 Senate general election. I am making this contribution with my own personal
funds and not with funds provided by any other person.

Signature Required: Second Signature for Joint Accounts:

Contributions to Gillibrand for Senate are subject to the prohibitions and limitations of the Federal Election Campaign Act. An individual may
contribute a maximum amount of $2,400 per election (the primary and general are separate elections) to a federal candidate. Federal multi-
candidate political action committees (PACs) may contribute up to $5,000 per election. Contributions from corporations, labor organization
treasury funds, foreign nationals, and federal government contractors are prohibited. All contributions must be from the contributor's personal
funds. Corporations and individuals are strictly prohibited from reimbursing another person for making a contribution to Gillibrand for Senate.

To comply with federal law, we must use our best efforts to obtain and report the name, mailing address, occupation and employer of all
individuals whose contributions aggregate in excess of $200 per election cycle.

Contributor #1:

Name: E-Mail:

Occupation: Employer:

Address:

City: State: Zip:

Home Phone: Work Phone:

Mobile Phone: Fax:

Contributor #2 (if applicable):

Name: E-Mail:

Occupation: Employer:

Address:

City: State: Zip:

Home Phone: Work Phone:

Mobile Phone: Fax:

Contributions to Gillibrand for Senate are not tax deductible for federal income tax purposes.
Paid for by Gillibrand for Senate.

3/26/09DC