2025 ARTC General Donation

Email*

Send me updates by email(not needed for receipts)

Phone*

Send me updates by text*

* By providing your phone number, you are consenting to receive text message updates, including automated text messages, to that number from Avon Republican Town Committee. Message & Data rates may apply, and message frequency may vary over time. Reply "STOP" to opt out of these text message updates.

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Are you currently employed?

YesNo

Employer Name*

Occupation*

Employer: If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide Name of Business. (Example: Dave's Painting. Other examples: Retried, Unemployed, Student, Homemaker.) Principal Occupation: If self-employed, provide job Description (Example: Painter Other Examples: Retired, Unemployed, Student, Homemaker)

Is contribution being made from the account of a sole proprietorship?*

Yes No

Age*

18 & Over12-17 ($30 MAX)12 & Under (PROHIBITED)

Name of Sole Proprietorship

If yes, and the name is different than the individual contributor, list NAME OF SOLE PROPRIETORSHIP

Are you a principal of a state contractor or prospective state contractor? If Yes, please indicate which branch or branches of government the contract(s) is with.*

NoYes, ExecutiveYes, LegislativeYes, Executive & Legislative

Are you a communicator lobbyist, OR the spouse or dependent child of a communicator lobbyist? (Communicator lobbyist may not make contributions to General Assembly candidates during the legislative session.)*

NoYes

Requirement

I certify that I am NOT a principal of a state contractor or prospective state contractor.

I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that I have provided my residential address.

I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization or any other entity.

I hereby certify that all of the information disclosed by me on this contributor form is true and accurate to the best of my knowledge and belief.

Click here to read legal definitions.

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