On Sale

Tickets

General Admission$25
0

Choose Donation Amount

Cover the fees

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

If yes, please indicate which branch or branches of government the contract(s) is with.


I understand that under Public Act 10-1, communicator lobbyists and their immediate family members are permitted to give contributions of up to one hundred dollars in the aggregate to party committees.


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


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 this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.


Click here for definitions of items on this form.

Are you currently employed?

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: Retired, Unemployed, Student, Homemaker. Principal Occupation - If self-employed, provide Job Description. Example: Painter; Other Examples: Retired, Unemployed, Student, Homemaker.