Club Membership Application

• [ ] New
• [ ] Renewal

Date: _________________________________________________________

Name:_________________________________________________________

Preferred pronouns: __________________________________________

Address:_______________________________________________________

Email Address: @____________

Phone Number: _______________________________________________

Memberhsip level:

• [ ] Individual
• [ ] Senior/Student
• [ ] Angel

Registration:

• [ ] Registered Democrat, or intend to register as a Democrat when eligible
• [ ] Not a registered Democrat

I'd like to get involved in:

• [ ] Political Action

• [ ] Fund Raising

• [ ] Publicity

• [ ] Computer

• [ ] Telephoning

• [ ] Mailing

• [ ] Newsletter

• [ ] Membership

• [ ] Refreshments