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*Age Greater
Than 18
*Certification agreement (check the box to agree):
* I hereby certify 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 not associated with a business that has a contract with the city of New London that is valued at more than $5000, and that if I am a communicator lobbyist or a member of the immediate family of a communicator lobbyist, I have disclosed this under Principal Occupation above (See Definition of Terms if you are uncertain of these terms). I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I am 18 years of age or older. I certify that this contribution is made on my personal credit card for which I have a legal obligation to pay and intend to pay from my own personal funds; payment on this card is not made from the funds of a corporation, labor organization or any other entity.