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

Name *

First

Last

Street Address *

Mailing Address (if different) *

City *

Zip Code *

Telephone No. *

Cell No. *

Email *

Annual Membership Dues *

Member - $15 / Per Person Youth (under 25) - $5 Supporting Member - $50 / Per Person Century Member - $100 / Per Person Other

*Supporting, Century and “Other” contributions will be directed to our Campaign Fund in support of services or donations to our endorsed candidates.

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

$10 $15 $20 $30 $50 Other

Please remind me of my commitment: *

Yes No, thanks.

Please help me set up an automatic withdrwal payment *

Yes No, thanks.

The following is required by the Washington State Public Disclosure Commission on contributions over $100 per election cycle:

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: *

Serving as Acting or Appointed Precinct Committee Officer Staffing the Office Entering and Managing Data (computer skills required; we'll teach you!) Identifying Democrats Getting out the Vote Phone Banking Doorbelling Writing Letters to the Editor Marching in Parades Staffing the Fair Booth Putting up/Locating Yard Signs

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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