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SJCDCC Membership Form
We appreciate your interest in joining the San Joaquin County Democratic Central Committee! If you haven't already, please review the following documents before proceeding:
http://sjcdems.org/wp-content/uploads/2015/08/SJCDCC_Bylaws_2015_FINAL.pdf
http://sjcdems.org/wp-content/uploads/2017/01/SJCDCC_PPs_FINAL.pdf
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Legal Name
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This should be the name that you used on your voter registration form and/or driver's license.
Your answer
Preferred Name (if applicable)
Your answer
Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Mailing Address (if different from residential address)
Your answer
Preferred Email Address
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Your answer
Date of Birth
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MM
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DD
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YYYY
Phone Number (landline)
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Phone Number (cell)
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Your answer
What is your County Supervisorial District?
Choose
District 1 (Miguel Villapudua)
District 2 (Paul Canepa)
District 3 (Tom Patti)
District 4 (Steven Ding)
District 5 (Robert Rickman)
What is your State Assembly District?
Choose
District 9 (Heath Flora)
District 13 (Carlos Villapudua)
What is your Congressional District?
Choose
District 9 (Josh Harder)
District 13 (John Duarte)
For filing purposes, please provide us with the following information.
If you are unemployed, please answer both fields with "Unemployed."
Occupation
*
Your answer
Employer
*
Your answer
The information provided above should correspond with your current voter registration. We are required to verify your registration, applicable districts, and party affiliation prior to you being seated on the San Joaquin County Democratic Central Committee.
Please sign by typing your initials here.
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