General Fund

Email*

Send me updates by email(not needed for receipts)

Phone*

Send me updates by text*

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

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

NAME OF EMPLOYER*

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

Are you 18 or older?*

If not, please list your age:

Are you a communicator lobbyist?***

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

If yes, are you an elected public official?

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

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

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?*

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