Please check yes for all the committees you are interested in.
Who should we contact in case of an emergency?
Do you have any health issues we should be made aware of?
Agreement & Signature
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 firstname.lastname@example.org or text/call 407-323-6161.
OFFICE USE ONLY
Voter ID _______________ Precinct ________ Payment _________ Amount __________ Membership Card ____/____/____