Reception fundraiser for

Riverside County District Attorney

Rod Pacheco

Wednesday, May 12, 2010

5:30 p.m. - 8:00 p.m.

Home of Ed & Judy Adkison

2296 Monroe

Riverside, CA 92506

$100 per person

Silver Sponsor $1000 per group of 10

Gold Sponsor $2500 per group of 10

Platinum Sponsor $5000 per group of 10

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations at $100 per person

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations as a Silver Sponsor @ $1000 per group of 10

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations as a Gold Sponsor @ $2500 per group of 10

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations as a Platinum Sponsor @ $5000 per group of 10

__No, I cannot attend please make accept my donation of   

Guest Names:  

Election law requires the following information:

Name:

Address:

City:

State:

ZIP:

Phone:

FAX:

E-mail:

Employer:

Occupation:

NOTES:

You may press the send button and it will be automatically

emailed to us or print this page and fax back to 951-686-1998

Please make checks payable to:

Rod Pacheco for District Attorney

3711 A. Arlington Ave.

Riverside, CA 92506

I.D.# 1267041

Not printed or distributed at government expense.

Corporate and personal checks accepted.