Democratic Women's Club of Volusia County

PARTICIPATE IN THE WORLD OF POLITICS

Membership application

                        NAME_________________________________________________

                        ADDRESS______________________________________________

                        CITY__________________________________ZIP_____________

                        (________)_________________________________     HOME Phone

                        (________)_________________________________     WORK Phone

                        (________)_________________________________    CELL Phone

                        E-MAIL_____________________________________

                        CONGRESSIONAL DISTRICT _____________

                        STATE SENATE DISTRICT _______________

                        STATE HOUSE DISTRICT ________________

                        COUNTY COMMISSION DIST ____________

                        SCHOOL BOARD DISTRICT______________                 

I verify that I am a registered Democrat in Volusia County

Voter Precinct No.________________________________

Voter Reg. No.___________________________________ 
 
I HEREBY CERITFY THAT I AM A MEMBER OF THE DEMOCRATIC PARTY OF FLORIDA WHO SUPPORTS ACTIVE INVOLVEMENT AND INFLUENCE OF CITIZENS IN POLITICS AND GOVERNMENT AFFAIRS IN MY COUNTY, THE STATE OF FLORIDA AND THE UNITED STATES OF AMERICA.
 

__________________________________________          ____________________
SIGNATURE                                                                                   DATE
 
Make your check payable to:
Democratic Women’s Club Of Volusia County
       
Send to:
Lisa Walker, 2nd Vice President / Membership Chair
1194 N. Old Mill Drive
Deltona, FL 32725 

Or bring to an upcoming meeting