2024 Membership Application Form
PLEASE SUBMIT ONE FORM FOR EACH CLUB MEMBER
We request that you fill out the application form each year. This ensures that we have your most current and correct information.  Our Bylaws require every club member to be a Democrat registered to vote in Volusia County.

Note: If you have filled the 2024 Membership Form and need the information from the Confirmation page please do not fill out another form. Please email us at sevolusiademocrat@gmail.com. Thank you.
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Membership *
Are you a New Member or a Renewing Member for 2023
First Name *
Last Name *
Email Address *
If you do not have an email address, please enter N/A
Phone *
Please list the number you use the most. If you do not have a phone number, please enter N/A
Contact
For the number listed above is it a house phone or a cell phone
Clear selection
Messages
Is it ok to leave voice mail messages or send text messages?
Clear selection
Street # *
Street Name *
Apt. #
If applicable
City *
State *
Zip *
Resident Status *
Year Round or Partial Year
Employment *
Occupation *
Current or Previous 
Media *
I give permission to use photos of me at SEVDEM events and activities of the Southeast Volusia Democratic Club. I allow my photo to be used on the Club Website, Instagram, Twitter, and other media sites.
Membership Levels *
$25.00 Base Membership Dues
$25.00 Base Dues + $25.00 Donation =$50.00
$25.00 Base Dues + $50.00 Donation =$75.00
$25.00 Base Dues + $75.00 Donation =$100.00
Student Rate is $5.00 for full time students 18 years and older            
Payment *
Select below the payment method you prefer.
Information and links will be found on the confirmation page when you submit this form.
Signed *
By typing my name below I am stating I understand and agree with the following statements:
I affirm I am a registered Democrat eligible to vote in Volusia County, FL.
I affirm and support the principles of both the National and Florida Democratic Party.
I understand my Democratic voter registration will be verified with the County Supervisor of Elections.
I attest that the above information is true and accurate. Please type your name below to sign and indicate you agree with the above statement.
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