Senate Democrats Victory PAC

Email*

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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 Senate Democrats Victory PAC. 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.

Are you currently employed?*

YesNo

Employer Name

Principal Occupation

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). 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

** Note that under Public Act 10-1, communicator lobbyists and their immediate family members are permitted to give contributions of up to one hundred dollars in the aggregate to legislative leadership and legislative caucus committees. Note that communicator lobbyists are prohibited from making such contributions during the legislative session.

Are you the spouse OR dependent child of a communicator lobbyist?

YesNo

If yes, are you an elected public official?

YesNo

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

YesNo

Connecticut General Statutes § 9‐612 (g) (2) (B), provides in part that no state contractor, prospective state contractor, principal of a state contractor or principal of a prospective state contractor, with regard to a state contract or state contract solicitation with or from the General Assembly or a holder, or principal of a holder of a valid prequalification certificate, shall make a contribution . . . to a political committee authorizedtomakecontributionsorexpenditurestoorforthebenefitofsuchcandidates. Legislativecaucuscommitteesandlegislative leadershipcommitteesareauthorizedtocontributetocandidatesforGeneralAssembly. SeeGeneralStatutes§9-618(d)(1).

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

ExecutiveLegislative

If you answered “yes” to the previous question, are you an elected public official?

YesNo

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

YesNo

Requirement*

I certify that I have provided my current residential address above. If any address information was auto-filled, I have reviewed it and made any necessary corrections for accuracy.
I certify that I am either a United States Citizen or foreign national with permanent resident status in the United States.
I certify that this contribution is being made on my personal debit or credit card for which I have 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, and is not an otherwise prohibited contribution and that payment is not made from the funds of a corporation, labor organization, or any other entity.
I hereby certify that all information disclosed by me on this form is true and accurate to the best of my knowledge and belief. I have read the definitions in the link below.

Definition of Terms - Legislative Leadership PAC

Click here to read legal definitions.

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