General Fund

Email*

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Phone*

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First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Employer (Please note: If self-employed, provide Name of Business. Examples: Dave's Painting, Retired, Unemployed, Student, Homemaker):*

Principal Occupation (Please note: If self-employed provide Job Description. Examples: Painter, Retired, Unemployed, Student, Homemaker):*

Are you 18 years of age or older?*

Are you a communicator lobbyist?*

No Yes

Are you the spouse or dependent child of a communicator lobbyist? If yes, are you an elected public official?*

No Yes

Do you or a business with which you are associated have a contract with the town, city or borough in which the candidate is running that is valued at more than $5,000?*

I am purchasing tickets for an upcoming fundraiser*

I am purchasing tickets for an upcoming fundraiser

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