Membership Application for the NW Democratic Club First Name(Required) Last Name(Required) Email(Required) Best phone number(Required)Type of phone?(Required) Cell Landline Date of Birth(Required) MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Annual Club Memberships General ($25) Student ($10) T-Shirt Size(Required) Small Medium Large XL XXL XXXL Volunteer CommitteesPlease check yes for all the committees you are interested in. Community Engagement & EventsIdentify organizations throughout our service area that need volunteers/support to show our commitment and involvement in the community. Secure and coordinate participation in various events throughout our service area as a host or participant. Yes - Community Engagement & Events FundraisingCoordinate activities that will provide additional revenue to support candidates running for office. Yes - Fundraising Marketing & CommunicationsCreate, distribute and share consistent messaging to the community that supports our mission to engage voters, register voters, and get out the vote through the website, email campaigns, social media platforms, and print media. Yes - Marketing & Communications Membership & HospitalityRecruit, engage, and retain members to support the club's mission. Attend events and serve as ambassadors at meetings and club-organized events. Yes - Membership & Hospitality Tell Us More!Who should we contact in case of an emergency?Name First Last PhoneRelationship Do you have any health issues we should be made aware of?Response Here Agreement & SignatureDate(Required) MM slash DD slash YYYY By adding my name and the date, I affirm that I am now registered with the Volusia County Supervisor of Elections to vote as a member of the Democratic Party. I understand and agree that I have a continuing obligation to inform the NW Volusia Democratic Club immediately, should there be any change in my voter registration.If you have any questions or require additional information, please email Membership Chair Donna Cochran at d.cochran@nwdemocrats.org or text/call 407-323-6161.Name(Required) First Last OFFICE USE ONLYVoter ID _______________ Precinct ________ Payment _________ Amount __________ Membership Card ____/____/____
