Lincoln Day Dinner Order Form

T he 2009 L incoln D ay D inner Tuesday, June 23, 2009 • Please reply by Tuesday, June 16, 2009 Name(s)____________________________________________________ Address_____________________________________________________ City____________________State______ Zip_______________________ Phone_______________________ Fax____________________________ E-Mail______________________________________________________ Occupation (if check is over $100)______________________________

EVENT TICKETS - $50 ea. # OF TICKETS

PATRONS TABLE - $1500

TOTAL ENCLOSED

Table for 10 with preferred table location # OF TICKETS

I would like to buy an extra ticket(s) for a teen or Young Republican

CHAIRMANS CIRCLE - $500 Membership includes two tickets for the Lincoln Day Dinner. Check enclosed for $50

TOTAL ENCLOSED

STATESMAN’S SOCIETY - $1000

Membership includes two tickets for both Lincoln Day and the Statesman of the Year dinners. Check enclosed for $1000

GOVERNOR’S CLUB - $5000

Membership includes a 10 seat table for both Lincoln Day and a preferred table at the Statesman of the Year dinners. Check enclosed for $5000 Please make checks payable to: The Republican Party of Sarasota County Please see reverse side for payment by Credit Card

T he 2009 L incoln D ay D inner Our guests for the 2009 Lincoln Day Dinner include: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Tables seat ten guests Please respond promptly, seating is limited.

You may remit payment by Credit Card: Name on Card_____________________________________ [ ] VISA

[ ] MasterCard

[ ] American express

Credit Card #______________________________________ Expiration Date_ _______________CW#________________ (The CW# is the last three numbers on the back of your card) Please help send a teenage Area Republican or Young Republican to the dinner by purchasing a $50 ticket for them. Just add TR or YR to the guest list and add the cost of the

ticket(s) to your check or credit card payment.