Membership Application Form

CLALLAM COUNTY DEMOCRATS

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Clallam Democrats Membership Form

If you prefer to complete a paper form, access one here: PDF Form

* Indicates required field

Date *

Precinct (if known) *

Name *

First

Last

Street Address *

Mailing Address (if different) *

City *

Zip Code *

Telephone No. (landline) *

Cell No. *

Email *

Would you like to receive the CCD Newsletter? *

Yes No

Annual Membership Dues *

Member - $20 / Per Person Youth (under 25) - $5 Supporting Member - $50 / Per Person Century Member - $100 / Per Person Other

I would like to make a MONTHLY pledge to support the CCD Headquarters. *

$10 $15 $20 $30 $50 Other

For contributions over $100 per election cycle, the Washington State Public Disclosure Commission requires the following information:

Occupation *

(Required by the WA Public Disclosure Commssion)

Employer (or retired) *

Employer Address (if applicable) *

YES, I will help the Clallam County Democrats by....

Choose any: *

Helping staff the CCD office Work on finance topics/issues Enter and manage data (basic computer skills required) Help my local Precinct Committee Officer (PCO) Identify Democrats Get out the vote Phone banking Doorbell/Distribute campaign material Put up yard signs/Identify yard sign locations Write letters to the editor March in parades Staff the Fair booth

Other (special skills I have): *

Please make checks payable to
Clallam Democrats
Box 2454
Port Angeles, Washington 98362
or
pay online with

Thank you for your help and support!

Submit

Clallam County Democrats | 124-A West First Street | Port Angeles, WA 98362 | 360-452-0500

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