� This contribution to Friends of Connie Mack represents my personal funds and is not drawn on an account maintained by an incorporated entity.

� Yes, I/We will attend the reception. Please reserve _____ ticket(s) at $500 per person ☐ Yes, I/We will contribute the maximum to Friends of Connie Mack. ($5,000 per person/ $10,000 per couple) ☐ I/We cannot attend the event, but would like to contribute $____________________. ☐ Please charge $____________ to my: ☐ Visa ☐ MasterCard ☐ Amex ☐ Discover Card Number: _______________________________ Exp: ________________ 3 or 4-digit Security Code: ______________ Name as it appears on card if different from below: ____________________________________________________________ Billing Address: ________________________________________________________________________________________________

Please make checks payable to: "Friends of Connie Mack"

mail to: PO Box 14-1129, Coral Gables, FL 33114 or fax to: (850) 270-6908 **may also contribute via www.conniemack.com

Individuals may contribute up to $2,500 to the primary election and $2,500 to the general election. PACs may contribute up to $5,000 to the primary election and $5,000 to the general election. Political contributions are not deductible as charitable contributions for the purposes of federal income tax. Federal law requires political committees to report the name, mailing address, occupation and name of employer of individuals

whose contributions exceed $200 per election cycle. Contributions from foreign nationals are prohibited. No corporate checks or corporate credit cards may be accepted.

________________________________________________________________________________________________________________________ Your Name Spouse’s Name ________________________________________________________________________________________________________________________ Address City State Zip ________________________________________________________________________________________________________________________ Home Phone Office Phone Fax Email Address ________________________________________________________________________________________________________________________ Employer Occupation ________________________________________________________________________________________________________________________ Spouse Employer (if joint contribution) Spouse Occupation (if joint contribution) ________________________________________________________________________________________________________________________ Signature Spouse Signature (if joint contribution)

Event Code: E120723

HOST COMMITTEE

DR. JAVIER GARCIA-BENGOCHEA RICHARD BROWDY

ED BURR GARY & NANCY CHARTRAND

MARTY FIORENTINO JOE MOBLEY

DICK MORALES FITZHUGH K. POWELL DR. SHYAM PARYANI

TOM PETWAY AMBASSADOR JOHN ROOD

KENT & CHRISTIE STERMON CHRIS VERLANDER

(HOST COMMITTEE IN FORMATION)

CORDIALLY INVITE YOU TO A FUNDRAISING RECEPTION IN SUPPORT OF

CONGRESSMAN CONNIE MACK FLORIDA'S NEXT UNITED STATES SENATOR

MONDAY, JULY 23, 2012 5:00 P.M. – 6:30 P.M.

AT THE HOME OF MATT & SHANNON CONNELL

2817 FOREST CIRCLE � JACKSONVILLE, FLORIDA

MINIMUM SUGGESTED CONTRIBUTION $500 PER PERSON

RSVP TO CHERYL SEINFELD AT 305-456-2389 OR CHERYL@CONNIEMACK.COM

Paid for by Friends of Connie Mack, Inc.