Salisbury Democratic Town Committee

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Salisbury Democratic Town Committee!

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Phone*

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

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Employer Name*

Principal Occupation*

If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide name of business (Example: Dave's Painting. OtherExamples: Retired, unemployed, Student, Homemaker).

Mailing Address:*

Are you 18 years of age or older*

Are you a communicator lobbyist?*

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

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

Are you an elected public official?*

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

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Requirement*

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Card Number*

Exp. Date*

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