MEMBERSHIP FORM

Application or Renewal for 2020 by Check

 

To join or Renew by Credit Card do not complete this form, go to:

                    secure.actblue.com/donate/mems2020

 

REGISTRATION AS A DEMOCRAT IS REQUIRED FOR MEMBERSHIP

(Please print clearly)

 

 

Name/Names:  ­­­­­­­­­­­­­­­____________________________________________________________________________

 

Address:  _____________________________________City: ____________      State:_________ Zip:_______

 

Telephone Numbers:  Home_____________________________Cell__________________________________

 

I agree to receive automated phone call reminders at this number (initial here):___________

 

Email (Please PRINT clearly) _________________________________________________________________

 

Check one:  RENEWAL _______  NEW MEMBER(S) _______                Date of Application: ______________

 

County and State where you are a registered Democrat: _____________________________________________

 

 

PAY 2020 Dues: (Check the one that applies)

 

     Individual: $30 ________       Household (2 or more): $45 ________        Youth/Student: $10 __________

 

     Century Individual: $100 ____Century Household (2 or more): $150 ____  Sustaining: $250 _________

                               

Print and complete this form with check payable to Democrats of the Desert, and mail to:

DOD, 68733 Perez Road C-7, #162, Cathedral City, 92234-7306

 

 

CA FAIR POLITICAL PRACTICES COMM. REQUIRES THE FOLLOWING INFORMATION:

 

Occupation: _____________________________ Self-Employed:  ____________     Retired:____________

 

Business/Employer: _________________________________  Business Phone: ________________

 

Address: ________________________________ City _________________ State ____ Zip_______

 

Democrats of the Desert  •  California FPPC # 870135  •  FEC ID: C00422428     

    08-06-2020