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Age (Please see restrictions regarding Contributions from Minors)*
Are you a communicator lobbyist or the spouse or dependent child of a lobbyist?*
Are you an elected public official?*
Are you a principal of a state contractor or prospective state contractor? If yes, please indicate which branch or branches of government the contract(s) is with:*
Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?*
Residential Address (If different from Billing Address provided (NO PO BOXES); write SAME if no change)*
Employer: If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide Name of Business. (Example: Dave's Painting. Other Examples: Retired, Unemployed, Student, Homemaker)
Principal Occupation: If self-employed, provide Job Description. (Example: Painter. Other Examples: Retired, Unemployed, Student, Homemaker)
