Leland for Ward 18

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Send me updates by email(not needed for receipts)

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Last name*

Residential Address*

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City*

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Zip*

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Are you 18 years of age or older?*

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Are you a lobbyist?*

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

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Certification*

I confirm that the below statement is true and accurate.

I hereby certify that this contribution is made on my personal debit card or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds; payment on this card is not made from the funds of a corporation, labor organization or any other entity.

Requirement*

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

I also affirm that I am either a United States citizen or a foreign national with permanent resident status in the United States.

I further affirm that I am not a lobbyist and that I do not have a contract with the city of New Haven valued at over five thousand dollars nor am I associated with a business that does.

Are you currently employed?

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Employer Name

Occupation

Employer Address

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City

State

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This form only accepts US addresses.

Leland for Alder

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