Sample Club Membership Form

Club Membership Application

[ ] New

[ ] Renewal

Date: _________________________________________________________

Name:_________________________________________________________

Preferred pronouns: __________________________________________

Address:_______________________________________________________

Email Address: @____________

Phone Number: _______________________________________________

Memberhsip level:

[ ] Individual

[ ] Senior/Student

[ ] Angel

Registration:

[ ] Registered Democrat, or intend to register as a Democrat when eligible

[ ] Not a registered Democrat

I'd like to get involved in:

[ ] Political Action

[ ] Fund Raising

[ ] Publicity

[ ] Computer

[ ] Telephoning

[ ] Mailing

[ ] Newsletter

[ ] Membership

[ ] Refreshments

[ ] Voter Registration

[ ] GoTeam

[ ] Programmimg

[ ] Other: _________________________________________________________

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