Town of Chester Republican Town Committee

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Mailing Address*

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Are you currently employed?

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Employer Name

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I am either a United States citizen or a foreign national with permanent resident status in the United States.*

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Are you a communicator lobbyist?*

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

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

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

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If you answered “yes” to the above question, 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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I am eighteen years of age or older (applicable to contributions exceeding $30)*

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This contribution is made on my personal credit card for which I have a legal obligation to pay and intend to pay from my own personal funds; payment on this card is not made from the funds of a corporation, labor organization or any other entity

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