CONTRIBUTION FORM

Although there are many levels to assist our political activities, for a large majority, our party's
get-out-the-vote activities are fueled by small dollar donations coming from a wide spectrum of people across
Westport. Often, contributions of $10, $20, $50 and $100 make our Election Day efforts a huge success.


Name:
Address:
City: State: Zip:
Phone:  
Email:  


Lobbyist:
Are you the spouse
of a lobbyist?
Are you the dependent
of a lobbyist?

Do you have a contract
with the State of CT
valued at more than $5,000?
Are you a director, officer,
limited or general partner or
holder of 5% stock in a
business which has a
contract with the State of
Connecticut valued at more
than $5,000?

Please make checks payable to Westport RTC

Once you have filled this form in please use your browser to print it out.
You can then mail this form along with your contribution to:

Westport RTC, PO Box 601, Westport CT, 06880

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