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Amount *

    • Min. $5, Max. $2,000

Disclosures (as required by the State of CT) *

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* Are you a communicator lobbyist?
* Are you the spouse or dependent child of a communicator lobbyist?
* Are you an elected public official?
* Are you a principal of a state contractor or prospective state contractor?
If yes, please check the branches of government with which you have a contract:

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

Certification *

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor form 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.

To donate by mail, print and complete this form:

Contributor Certification Form (pdf)

Mail completed form and personal check to:
NDTC, Attn: Treasurer, P.O. Box 128, Norwalk, CT 06853