Purchase your tickets for the Westport DTC Fundraiser today!  Join us Thursday, October 12th at 7:00pm, The Inn at Longshore

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I hereby certify that I am NOT a principal of a state contractor or prospective state contractor, and that I am NOT a communicator lobbyist or a member of the immediate family of a communicator lobbyist.

I understand that Connecticut law requires that a contribution be in my name and be from my own funds.

I hereby affirm that this contribution is being made from my personal funds, is not reimbursed in any manner, and is not being made as a loan.

I further certify that all of the information set forth above on this form is true and accurate to the best of my knowledge and belief.

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