General Fund

Thank you for supporting the Lyme Democratic Town Committee!

Choose Amount

Email*

Phone*

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*

Principal Occupation*

If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide name of business - i.e. Dave's Painting or Retired, Unemployed, Student, Homemaker if applicable. If self-employed, provide job description - i.e. Painter or Retired, Unemployed, Student, Homemaker if applicable.

Please select your age (if under 18, $30 per year can be accepted):*

Are you a communicator lobbyist?*

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

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

Are you an elected public official?*

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

Card Number*

Exp. Date*

CVC / CVV*

Zip*