Larimer County Democratic Party: Speech pictures

2010 Annual Dinner Reservation Form

Colorado state law requires that all donors who contribute $20 or more include their name, address, occupation, and employer with the donation.

Political contributions are not tax-deductible.

Name:

(required)

Address:

(required)

Occupation:

(required)

Employer:

(required)

E-mail address:

(required)

Phone Number:

(required)

I would like to contribute to a pool to defray dinner costs for students and military. Additional Amount Paid: $ Names of sponsors who contribute $50 or more will be listed in the dinner program.

Table Captain (if any)

Dinner Guests' Name & Menu Choices
(Dinners are $85 each - Student/Active Military $35 each)

Guest Name	Dinner Choice	Student/ Active Military

Additional Comments (e.g. Special Diet Requirements)

Reception Guests' Names:
Century Club members donate $100/year to LCDP; Century Club (couple), $150; Victory Club, $500/year; Millennium Club, $1000/year

Guests' Name

Century Club Victory Club Millennium Club

I am not currently a club member. Please add my donation of $ to cover my membership.
Century Club $100, Century Club (couple) $150, Victory Club $500, Millennium Club $1000.

Larimer County Democratic Party
606 S. Mason Street, Fort Collins, Colorado 80524
(970) 689-6391 | ldems@frii.com
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