Paid for by Obama Victory Fund 2012, a joint fundraising committee authorized by Obama for
America and the Democratic National Committee.
The Obama Victory Fund
Cordially invites you to a breakfast
with special guest
President Barack Obama
Thursday, February 16th, 2012
7:00 in the morning*
*Please note that due to security reasons doors will close promptly at 8:00am
At the home of Jeff and Nancy Stack
Corona del Mar, CA
Address will be provided upon RSVP
Please contact Lindsay Rachelefsky with any questions at
lrachelefsky@barackobama.com or (310) 200‑0966
Please RSVP online at:
http://my.barackobama.com/february16coronadelmarbreakfast?custom1=4796776
Paid for by Obama Victory Fund 2012, a joint fundraising committee authorized by Obama for
America and the Democratic National Committee.
Yes! I/we would like to attend the breakfast on February 16th:
☐$35,800 per individual: greet + breakfast
☐$10,000 per individual: photo reception + breakfast
☐$2,500 per individual: breakfast
☐I am unable to attend, but would like to support Obama Victory Fund by contributing: $___________
Name(s) of attendee(s): ____________________________________________________________________________
I was invited to attend by: __________________________________________________________________________
Please make checks payable to:
Obama Victory Fund 2012
6222 Wilshire Boulevard, Suite 280
Los Angeles, CA 90048
Fax: (312) 361‑8074
Total Amount: $________________
Obama Victory Fund 2012 does not accept contributions from currently registered federal lobbyists, registered foreign agents, political
action committees, or minors under the age of 16. Corporate and labor union contributions are prohibited.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals
whose contributions exceed $200 in an election cycle.
First & Last Name: ________________________________________________________________________________________
Address: ____________________________________________________________________________________________ ____
City/State/Zip: ____________________________________________________________________________________________
Employer: _______________________________________ Occupation: _____________________________________________
Work Phone: ____________________________________ Work Fax: _______________________________________________
Home Phone: ____________________________________ Email: __________________________________________________
Federal law prohibits foreign nationals, except lawfully admitted permanent residents of the U.S., from contributing to the Obama
Victory Fund 2012. By signing below, I certify that I am a U.S. citizen or lawfully admitted permanent resident of the U.S., the funds I
am donating are not being provided to me by another person or entity for the purpose of making this contribution, and that my
contribution shall be allocated as stated below.
Signature: ________________________________________________________________________________
2nd Signature, If Contributing From Joint Account*: ____________________________________________
Contribute by Personal Check:
Please make checks payable to “Obama Victory Fund 2012” and mail to the address listed above.
Contribute by Credit Card:
Please bill my personal credit card: Visa MasterCard AMEX Discover
Card Number: ____________________________________________________________________Exp: __________________
Name as it appears on the card: ____________________________________________________________________________
Signature: _______________________ _________________________________________________________ ______________
Second Name on Account, if Joint Account*: _________________________________________________________________
*Contributions will be evenly attributed between names.
2nd Name Employer: _________________________ 2nd Name Occupation: _____ ________________________________
Second Signature for Joint Account: _______________________________________________________________
Contributions or gifts to Obama Victory Fund 2012 are not tax deductible.
The first $5,000 of a contribution to OVF 2012 will be allocated to Obama for America (with the first $2,500 designated for the primary election, and
the next $2,500 for the general). The next $30,800 of a contribution will be allocated to the Democratic National Committee. A contributor may
designate a contribution for a particular participant. This allocation formula may change if following it would result in an excessive contribution.
CA438
RafielMelahat
Click here to contribute online: http://my.barackobama.com/february16coronadelmarbreakfast?custom1=4796776