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News
Events
Elected Officials
Members
Contact
Contribute

Contribute

Questions concerning definitions and limits? You can review those here, on page 2.

Name(Required)

First Last

Is contribution being made from the account of a sole proprietorship?(Required)

Yes

No

If yes, and name is different than individual contributor, list NAME OF SOLE PROPRIETORSHIP(Required)

Email(Required)

Enter Email Confirm Email

Register to receive communications from us?

Sure!

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Are you 18 or older?(Required)

Yes

No

If you are not 18 or older please list your age(Required)

Employer

Principal Occupation

Are you a communicator lobbyist or the spouse or dependent child of a communicator lobbyist?(Required)

Yes

No

If yes, are you an elected public official?(Required)

Yes

No

Note that as an elected public official, aggregate contributions are limited to $100.

Are you a principal of a state contractor or prospective state contractor?(Required)

Yes

No

If yes, please indicate which branch or branches of government the contract(s) is with

Legislative

Executive

Are you an elected public official?(Required)

Yes

No

Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?(Required)

Yes

No

Do you certify each question in this form has been answered truthfully?(Required)

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.

I agree.

Today's Date(Required)

MM slash DD slash YYYY

Your Contribution to the Glastonbury Republican Town Committee

Please consider adding $5 to cover credit card processing fees.

Contribution Amount(Required)

Purpose(Required)

Select one of the following as the purpose for your contribution:

Event Name(Required)

Payment Method*

American Express

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MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Contribute by Mail

Download, print and complete our Individual Contributor Certification Form. Ensure you have filled out the entire form and signed before returning.

Mail the form with your check or money order made payable to the Glastonbury RTC.

Glastonbury RTC
PO Box 1228
Glastonbury, CT 06033

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Glastonbury RTC
PO Box 1228
Glastonbury, CT 06033

JOIN GLASTONBURY REPUBLICANS

Glastonbury Republicans believe in responsible, open and collaborative government.

Become a part of the Glastonbury Republican Town Committee. Contact us via email for more information.

REGISTER TO VOTE

Are you new to Glastonbury? Are you concerned about the town's future? Register to vote.

You may also visit the Registrar of Voters at Town Hall, 2155 Main Street in Glastonbury.

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© Copyright 2023 Glastonbury Republican Town Committee. All Rights Reserved.

Paid for by the Glastonbury Republican Town Committee, Phil Markuszka, Treasurer