Donate Now!
I am so grateful to have you on our team as we build Darien's future. Your financial contribution helps pay for digital advertising, direct mail, voter contact software, and everything else necessary to run a 21st century political campaign. To contribute, we have a simple, two step  process:

1) Fill out the below form with your name, address and a few required questions from the State Election Enforcement Commission.

Once you click "Submit" you will be prompted to click a redirect link to:

2) Contribute directly with your PayPal account or your Credit/Debit Card.

If you have any questions at all about this form or the contribution process, please e-mail friendsoftaraochman@gmail.com and we'll be happy to help you out. Thank you again for your contribution, and I hope I'll see you soon at one of our in-person campaign events.

-Tara

Sign in to Google to save your progress. Learn more
Qualifying Contribution Certification Form:

The information below is required by the State of Connecticut to be collected from each contributor every time a contribution is made.  All items are required.

Please click the link below to read legal definitions:
https://seec.ct.gov/Portal/data/forms/SampleForms/DefinitionsofTermsMunicipalCandidates.pdf

First name *
Last name *
E-mail address *
Phone number *
Residential street address *
City, State, ZIP code *
Employer   (Please note: if self-employed, provide Name of Business.  Examples: Dave’s Painting, Retired, Unemployed, Student, Homemaker) *
Principal Occupation   (Please note: if self-employed, provide Job Description.  Examples: Painter, Retired, Unemployed, Student, Homemaker) *
Are you 18 years of age or older?   (Please note: $30 maximum contribution amount for contributors under age 18) *
Are you a lobbyist? *
Are you the spouse or dependent child of a lobbyist? *
Do you or a business with which you are associated have any contract with the Town of Darien that is valued at more than $5,000? *
Check here confirm that the following statements are true: *
- 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 I have provided my residential address- I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization or any other entity.
Required
Contribution amount *
Minimum contribution $10.00.  Maximum contribution $1,000.00.  Maximum contribution $30.00 if under age 18.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms