Beat Bush Bash                                              Sunday, June 13 at 7:00 pm

 

Contribution Form for John Kerry for President

 

I am contributing $______________ to the Kerry campaign.

         $50 (or more) per ticket to attend the Bash with Barney Frank, Jim McGovern,

                   the Rx Jazz band, and Jimmy Tingle.

         $500 (or more) per ticket to attend the Bash and the private reception with

                   Congressmen Frank and McGovern

 

_____Please register me for the Beat Bush Bash.

 

_____I am registering more than one person with this contribution.

 

         Other registrant(s) name(s): ________________________________________

 

_____I cannot attend, but I wish to contribute.

 

Make check payable to:  John Kerry for President, Inc.

If you have already contributed $2000 to John Kerry, you can purchase tickets for the Bash by making a contribution to either ÒKerry Victory 2004Ó or the ÒDemocratic National Committee.Ó Please contact us if you have any questions: (617) 795-1506 or email: bbbash@rcn.com

 

Mail your check with this form to: Ann Peck Reisen/BBB

                                         111 Perkins Street

                                         Boston, MA 02130

NAME________________________________________________________________

 

EMPLOYER____________________________________________________________

 

OCCUPATION__________________________________________________________

 

ADDRESS_____________________________________________________________

 

CITY____________________________________STATE_______ZIP_____________

 

HOME PHONE_________________________________________________________

 

OFFICE PHONE_______________________________________________________

 

EMAIL______________________________________________________________

I confirm that the following statements are true and accurate:

 

 1) I am a United States citizen or a permanent resident alien.

 2) I am making this contribution from my own funds, and not those of another.

 3) I am not a federal contractor.

 4) I am at least 18 years of age. 

 

Signature________________________________________________________________

 

Federal Election law requires John Kerry for President, Inc. to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Your contribution will be used in connection with Federal elections and is subject to the limits and prohibitions of the Federal Election Campaign Act.

 

Contributions or gifts to John Kerry for President Incorporated are not deductible for federal income tax purposes

 

All proceeds from the Beat Bush Bash go to the John Kerry for President campaign. However, Beat Bush is a grassroots group and is entirely independent of the Kerry for President campaign, is not an agent of the Kerry for President campaign, and is not affiliated with it in any official capacity.

For more information about the Beat Bush Bash:  http://users.rcn.com/bbbash/  email: bbbash@rcn.com or phone: 617-795-1506