General Fund

Wolcott Republicans are committed to advancing policies that protect freedom, strengthen communities, and ensure responsible government. Our principles guide our candidates, our endorsements, our public advocacy, and our approach to local and state government. Your donation helps fund our organization and assist our Republican candidates in elections.

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Email*

Phone*

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Please confirm age:*

Are you a communicator lobbyist?*

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

If yes, are you an elected public official?

Are you a principal state contractor or prospective state contractor? If so, which branch of state gov't?*

If yes, are you an elected public official?

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

Requirement*

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief.

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 this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.

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Are you currently employed?

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Employer Name*

Principal Occupation*

If multiple employers and one is a state contractor, list the state contractor. If selfemployed, 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.