A Gala Evening in Support of Attorney General Eric Schneiderman Wednesday, km 20, 2012 • Cocktail Reception from 6:00,pin to 8:00pm • 1/11) Reception at 5:30pm Grand le New York • At Grand Central Terminal • New York Cip Join the Event Committee s YES, 1/we would like tojoin the Event Committee at the following levek O Chair: Pledge to contribute/raise $25,000 (4 passes to VIP Reception • 10 passes to general reception) O Vice Chair: Pledge to contribute/raise $10,000 (2 passes to VIP Reception • 10 passes to general reception) O Patron: Pledge to contribute/raise $5,000 (1 pass to VIP Reception • 10 passes to general reception) O Sponsor. Pledge to contribute/raise $2,500 (8 passes to general reception) O Friend: Pledge to contribute/raise $1,000 (3 passes to general reception) Make a Contribution YES, II we would like to mood the allortty general's campaign. O I/we will attend the reception and have enclosed my/our contribution of: O $25,000 0 $10,000 0 $5,000 0 $2,500 0 $1,000 O $500 0 Other: $ (minimum $500 per person) O I/we cannot attend, but have enclosed my/our contribution(s) of $ Name@ ofattendee(s): Nattte(s) of Emit Committee AlemberN who ittritedyou, if any: For compliance with New York State Election Law and campaign guidelines, please complete the following. Name: Residential Phone: Employer: Business Phone: Title/Occupation: Primary Fax: Mailing Address: City, State, Zip: E-mail: For Contributors Only. Each contribution must be accompanied by a completed and signed contribution form. -1 Contributions by check Please make cheeks payable to SCHNEIDERMAN 2014 and mail with this form to: I ISA Fulton Street, Suite 250 New York, NY'10038-2712 Contributions by credit card Credit card rontribations may be faxed to (866) 532-0379. Card Number: Amount: $ Type: Expiration Date: The account being used to make this contribution is registered to and managed by a/an: O Individual ) sole Proprietorship