East Haddam Democratic Town Committee

Please join us in supporting our incredible slate of Democratic candidates in 2024!

For more information visit us at easthaddamdemocrats.org

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Email*

Phone*

First name*

Last name*

Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Name of Employer (If self employed list name of business)*

Principal Occupation (If self employed provide job description)*

Are you over 18 years old?*

If under 18 please list your age. Maximum contribution is $30

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

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

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

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

If 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?*

Comments:

Requirement*

I certify that I have provided my residential address.
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 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 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 definition of principal of a state contract or lobbyist

Card Number*

Exp. Date*

CVC / CVV*

Zip*