Wethersfield Democrats

Email*

Cell Phone*

First name*

Last name*

Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Principal Occupation:*

If self employed, provide job description (Ex. painter, attorney. Other Ex. retired, unemployed, student, homemaker)

Name of Employer:*

If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide name of business (Ex. Dave's Painting, Other Ex. Unemployed, Student, Homemaker)

Are you 18 years of age or older?

Are you a communicator lobbyist OR the spouse of a communicator lobbyist?*

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

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.

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

Are you an elected public official?*

Wethersfield Democratic Town Committee

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