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Copyright © 2001 to present all rights reserved Paid for by Radiofree West hartford, Donald J. Dodd Treasurer. |
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Yes, I want to help Build a Better More Conservative Connecticut and have enclosed a generous donation to Radiofree West Hartford. Please enroll me as a Sustaining Member. (Secure online donations of $50 or less can be made by clicking the donation link above.) q $750 q $500 q $250 q $100 q $50 q $25 Other $_____ Please make checks payable to Radiofree West Hartford (PAC) and remember political contributions are not tax deductible. Print and mail to: Radiofree West Hartford, 102 Saint Charles Street, West Hartford, CT 06119. Full Name: __________________________________________________________________ Employer: ___________________________________________________________________ Occupation: _________________________________________________________________ Home Address: _______________________________________________________________ _______________________________________________________________ City: ______________________________ State: ____________ Zip Code: _____________ Phone Number: ________________________ E-mail Address: _________________________ q Please sign me up for Radiofree West Hartford's E-mail alerts. Note: Your E-mail address will be kept confidential and NOT distributed or sold to other organizations. q Check if you are a Lobbyist, Spouse or dependent child of a Lobbyist. Radiofree West Hartford C/O Donald J. Dodd, Treasurer 102 Saint Charles St. West Hartford, CT 06119 State law now requires a certification accompany donations that exceed $50 Pursuant to C.G.S. § 9-608, I hereby certify and state that all of the information provided above is true and accurate to the best of my knowledge and belief and that I am NOT a principal of a executive branch state contractor, prospective state contractor, as defined C.G.S. § 9-612, as amended by P. A. 07-1. Note: To learn more about the litany of election laws that clearly hinder an individual's ability to Exercise Political Speech please contact the State Elections Enforcement Commission at (860) 256-2940. X______________________________________ Signature of Contributor Become more active in Connecticut politics q I want to volunteer and have an interest in writing, journalism, communications, graphics or website design. ______________________________________________________ q I want to volunteer but have other interests such as fundraising. _____________________ ____________________________________________________________________________ q I am presently active in Connecticut politics. ______________________________________ ____________________________________________________________________________ q I have worked on a political campaign. ___________________________________________ ____________________________________________________________________________ q Please help introduce me to my local Republican Town Committee. q Other ____________________________________________________________________ Radiofree West Hartford, 102 Saint Charles Street, West Hartford, CT 06119 Paid for by Radiofree West Hartford (PAC), Donald J. Dodd, Treasurer. |