Riverside County Supervisor

Bob Buster

Fundraiser

Thursday, December 1, 2010

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

Historic Mission Inn

3649 Mission Inn Ave.

Riverside, CA 92501

$150 Per Person

$250 Per Person Couple

$1000 Per Group of 6

$2500 Per Group of 8

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations at $150 per person.

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 VIP reception reservations at $250 per couple.

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations at $1000 per group of 6.

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations at $2500 per group of 8.

__Yes, I would like to attend please make 0 1 2 3 4 5 6 7 8 9 10 reservations at $1000 per person.

Guest Names:  

	Please complete the following for Credit Card payments: Card Holder Name: Credit Card Number: Amount Total: Card Type: Visa MasterCard American Express Discover Expiration Date: Security Code:

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:

Bob Buster for Supervisor - 2011

3711 A. Arlington Ave.

Riverside, CA 92506

I.D.#920450

Not printed or distributed at government expense.

Corporate and personal checks accepted.