Reception to Re-Elect Lt.

Governor David Dewhurst Wednesday, September 19, 2012

4:30 pm 6:00 pm Headliners Club Please RSVP to Suzy Balagia at 512-682-1081 or sbalagia@daviddewhurst.com

___ Yes!

I will support Lt. Governor David Dewhurst in his re-election campaign by contributing:

*____ $50,000 (give or raise by December 8, 2012) *____ $25,000 (give or raise by December 8, 2012) *Includes membership in the 2012-2013 Dewhurst Council ____$10,000 ____$5,000 ____$2,500 $___________ Other Tracking Number

______________________________________________________________________________
Full name (print name and/or spouse name as you would like to be listed on printed materials) Spouses name (if joint contribution) Address City Home Phone Fax Phone Employer Spouses Employer (if joint contribution) State Office Phone E-Mail Occupation Spouse Occupation (if joint contribution) Zip

Check Contributions The contribution to David Dewhurst Committee, drawn on check #_____ of the account named as ____, represents personal funds, is not drawn on an account maintained by an incorporated entity, and will not be reimbursed by another. Signature
If paying by credit card: ___ Visa ___ Mastercard ___ American Express Amount $___________ Expiration Date___________ VPN_________

Spouse Signature (if joint contribution)

Name on Card________________________________

Account Number____________________________________________

Signature_______________________________ Spouses Signature (if joint contribution) _______________________________

Please fax this form to 512-233-0564 Please make individual or PAC checks payable to David Dewhurst Committee No corporate checks, please. Mail to: P.O. Box 756, Austin, TX 78767 *Questions regarding Dewhurst Council Program, please contact Becca McMullen at 512-682-1087
State law requires (certain candidates, officeholders, or political committees, as applicable) to use best efforts to collect and report the full name and address, principal occupation or job title, and full name of employer of individuals whose contributions equal or exceed $500 in a reporting period. Pol. Adv. paid for by David Dewhurst Committee