ONLINE CONTRIBUTION FORM

Maximum allowable individual contribution is $2,000 per calendar year.

1. Complete the disclosure form below
2. Hit continue to be taken to Intuit’s secure payment gateway
3. Submit your credit card info to make donation.

2016 Disclosure Form

Connecticut General Statutes Section 9-608(c)(3) requires that each individual who makes a contribution(s) separately or in the aggregate, in excess of $50, to provide with
the contribution a certification that the contributor is not a principal of a state contractor
or prospective state contractor, nor a communicator lobbyist or a member of the
immediate family of a communicator lobbyist, and shall provide the name of the
employer of the contributor.

All fields are required

First name
Last name
Email address
Street
City
State
Postal code
Principal occupation
Name of employer
Are you a lobbyist?
Are you a spouse of a lobbyist?
Are you a dependent child of a lobbyist?
Are you a principal of a state contractor?