North Haven Republican Town Committee

Individual Contributor Certification Form

Show your support for the North Haven Republican Town Committee by making a contribution! Contributions can be between $5-$750. If you are buying a ticket for the 2026 Oktoberfest Fundraiser on Thursday, October 1st, at The Vue in Hamden, tickets start at $75 and can be purchased below.

Individual Ticket Purchase Form

Thank you for your support!

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Email*

Phone*

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Name of Employer:*

If multiple employers and one is a state contractor, list the state contractor. 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 years of age or older?*

YesNo

Are you a communicator lobbyist?*

YesNo

If you are an individual, are you the spouse or a dependent child of a communicator lobbyist?*

YesNo

Are you an elected public official?*

YesNo

If you are an individual, are you a principal of a state contractor or prospective state contractor?*

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

YesNo

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* 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 I have provided my residential address.

* I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization or any other entity.

* I hereby certify that all of the information disclosed by me on this contributor form is true and accurate to the best of my knowledge and belief.

Click here to read legal definitions.

*Paid for by the North Haven Republican Town Committee, Treasurer, Laurie-Jean Hannon.