2020 Lincoln-Reagan Dinner Registration Form

Number of Dinner Tickets by Support Level
If you are unable to attend the Lincoln-Reagan Dinner, but would be pleased to contribute and support the New Canaan Republican Party, please check off below
Are you a communicator lobbyist? *
 NoYes
Please check one
Are you the spouse or dependent child of a communicator lobbyist? *
 NoYes
Please check one
Are you an officer, director, limited partner, or general partner of a firm with a contract with the state of Connecticut valued at $50,000 or more? *
 NoYes
Please check one
Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services? *
 NoYes
Please check one
Do you certify that you are a U.S citizen or a foreign national with permanent resident status in the United States; and that this contribution is made with personal funds and is not being reimbursed in any manner; and that all of the information disclosed by you on this contribution form is true and accurate to the best of your knowledge? *
 NoYes
Please check one
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