Staunton Democratic Committee Membership Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Important: Please take a moment to fill out and submit your annual individual membership application. All fields are required. Your information will not be sold or given to other groups. It will be used for the sole purpose of communicating with you about Staunton Democratic Committee business. If you do not have the information needed to fill in a field, please enter N/A (For example if you do not have an email address, enter N/A as your email address).

First and Last Name *

Address *

Phone # (555-555-5555) *

Email Address *

Ward of Residence: Please select your Ward below. *

Ward 1

Ward 2

Ward 3

Ward 4

Ward 5

Please list your prior Democratic activities if applicable

Membership Dues

All Democrats are welcome to join! The Staunton Democratic Committee (SDC) suggests the following voluntary membership dues to support our headquarters' operating expenses, events and activities, as well as our candidates' campaigns:

$30.00 per person
$10.00 for a student

After you submit this form, there will be a link to our secure ActBlue donation page where you may make your contribution by debit or credit card. If you would prefer to pay by check, please make checks payable to Staunton Democratic Committee and mail to:

Staunton Democratic Committee
P.O. Box 152
Staunton, VA 24402

**Disclaimer: All monies collected by the Staunton Democratic Committee are used to advance the party's primary goals of electing democrats to office to represent us in city, state, and federal governments. Examples of expenditures include: headquarters rent, renter's insurance and WIFI, mailing expenses, supplies for campaign activities, get out the vote (GOTV) efforts, voter registration, costs associated with special events and fundraising efforts as we work hard to promote and contribute significant donations toward our democratic candidates' campaigns.

SIGNATURE: I declare myself to be a candidate for membership on the Staunton Democratic Committee. I also declare that I believe in the principles of the Democratic Party and that I will not support any candidate opposed to any Democratic nominee as long as I am a member of the Committee. Please enter your name again below as your signature.

Signature *

Date *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of SDC. Report Abuse

Forms