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HOST COMMITTEE FORM – Please Join Us! Fundraiser for Senator Dan Kapanke with Special Guest, Congressman Paul Ryan! Thursday, May 19, 2011, 5:30-7:30 p.m. Yahnke’s Antique Green, a private John Deere Museum 507 State Road (Cty Hwy D), Holmen ____Yes, I/we would like to be listed on the invitation as part of the host committee for this fundraiser. Invites will be mailed out next week. Please email or call in the names to Heidi by Sunday, May 8th. ____Platinum Host - $1,000 or more/individual or couple ____Gold Host - $500/individual or couple ____Silver Host - $250/individual or couple $1,000/person is maximum legal limit. Please list my name(s) on the invitation as: _____________________________________________________________ Address: _____________________________________________________ Phone: _______________________________________________________ Email: _______________________________________________________ Occupation & Employer address: _________________________________ (information required by law) Personal checks made payable to Kapanke for State Senate. Please send this form and check to: Heidi Green, Kapanke for State Senate 5210 Flad Avenue Madison, WI 53711 _____I/we have made our contribution via the website. Amount______ Any questions, or to relay information via email or phone, contact Heidi at 608.358.6116 or Authorized and Paid for by Kapanke for State Senate, Elizabeth Olsen,Treasurer.

Kapanke Ryan Fundraiser Event

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