To purchase tickets for the ____________ please complete the form below.
Event: ______________________________
Name(s) ___________________________________________
Address____________________________________________
City ________________________________ ST ___________
Zip _________________ Phone ________________________
E-Mail ____________________________________________
Occupation ________________________________________
(for state and federal political financial reporting requirements)
To ensure the best possible seating, please be sure to respond early.
# _____ Governor's Club Tickets @ $5000 $ _________ (includes Governor's Club Dues, plus 2 tickets to the annual Chairman's luncheon, plus 10 Statesman Patron Dinner tickets, plus 10 Lincoln Day Patron Dinner tickets, and recognition in our publications and event programs)
# _____ Statesman's Society Tickets @ $1000 $ _________ (includes Statesman's Society Dues, plus 2 tickets to the annual Chairman’s luncheon, plus 2 Patron Dinner tickets to the Lincoln Day, plus 2 Patron Dinner tickets to the Statesman Dinners, and recognition in our publications and event programs)
# _____ Chairman Circle Tickets @ $500 $ _________ (includes Chairman's Circle Dues, plus 2 tickets to the annual Chairman’s luncheon and 2 Patron Dinner tickets to Lincoln Day Dinner and recognition in our publications and event programs)
# _____ Patron Table for Ten Sponsorship @ $1500 (seating for ten @ $150 each) $ _________
# _____ Event Tickets @ $150 ea. $ _________
I/we cannot attend, enclosed is a contribution. $ _________
Please list your guests to the right and below:
You may remit payment by Credit Card:
Name on Card ______________________________________
[ ] VISA [ ] MasterCard [ ] American Express
Credit Card # ______________________________________
Expiration Date ___________________ CVV# ___________
(The CVV# is the last three numbers on the back of your card, four numbers for AmExpress)
If making credit card payment, please print this form, complete and either FAX to (941) 923-6898 or mail to the address below.
If using a check please print this form, complete and mail to the address below.
Kelly Erwin
c/o Republican Party of Sarasota County
4345 Sawyer Road
Sarasota, FL 34233
Please make checks payable to the Republican Party of Sarasota.
For more information call: 941-926-3567
