EastonCTDems

We are collecting donations for the Easton DTC General Fund. If you would like to support a specific outreach, please let us know: We accept donations for our Scholarship Fund and Our Elections Team as well as our General Operations Budget. Any additional contributions are, of course, accepted.

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Email*

Phone*

First name*

Last name*

Title

Suffix

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

Country*

This form only accepts US addresses.

Are you currently employed?*

YesNo

Employer Name*

Principal Occupation*

Are you a communicator lobbyist or the spouse or dependent child of one?*

Are you a principal of a state contractor or prospective state contractor?*

If yes, please please indicate which branch of government whether Legislative or Executive.

If you answered yes, to the previous question, are you an elected public official?

Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?*

Age:*

12 or Under is Prohibited.

Optional Special Designation:

Requirement*

By making this donation, I hereby certify and state that all of the information disclosed by me and set forth on any contributor card is true and accurate to the best of my knowledge and belief. I certify that the 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. I also certify that I am a United States Citizen or a foreign national with permanent residence status in the United States.

You understand that you are an individual making this contribution, not an organization.

*You may enter an alternate address in lieu of your residential address only if you are admitted to the Address Confidentiality Program pursuant to Connecticut General Statutes Section 54-240(a) or if you are one of the individuals with protected address status articulated in Connecticut General Statutes Section 1-217. ** Note that under Public Action 10-1 Communicator Lobbyists and their immediate family members are permitted to give up to $100 in the aggregate to party committees. If you are under the age of 18 years, and so indicate, you may not give a contribution in excess of $30.00.

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Exp. Date*

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