LA County Democratic Central Committee Associate Member Appointment Form

LA County Democratic Central Committee Associate Member Club Appointment Form
Name of Democratic Club*
Club President Name*

First NameLast Name
WE HAVE APPOINTED THE FOLLOWING AS OUR DEMOCRATIC CLUB REPRESENTATIVE TO THE LOS ANGELES COUNTY DEMOCRATIC PARTY:
Associate Member Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Birthdate

MonthDayYear
Date
Assembly District*
Resident (Voting) Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Public Mailing Address (skip if same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I acknowledge that LACDP will use email and text for member communications*

I accept
Would you like to volunteer?

YesNo
Please select 3 of the committees you may be interested in serving:

Ballot MeasuresBudgetCampaign ServicesCandidate InterviewCommunity OutreachCredentialsElection ProtectionEventsJudicial InterviewLaborLegislative ActionOrganizational Development and CharteringProgram and EducationResolutionsRules and LegalVoter Registration
CLICK HERE: Anti-Harassment Policy

CLICK HERE: LA Central Committee Code of Conduct
I have read and accept the LA Central Committee Code of Conduct*

I accept
I have read and accept the Anti-Harassment Policy*

I accept
I will be paying my Associate Member Dues of $68 using:*

ActBlue (preferred)CheckCash
Please open this link in a new window to pay your Dues via ActBlue
Please contact Annie Reyland, Director of Operations, at Annie@lacdp.org if paying by check or cash.
Should be Empty:

LA County Democratic Central Committee Associate Member Club Appointment Form

WE HAVE APPOINTED THE FOLLOWING AS OUR DEMOCRATIC CLUB REPRESENTATIVE TO THE LOS ANGELES COUNTY DEMOCRATIC PARTY:

CLICK HERE: Anti-Harassment Policy

CLICK HERE: LA Central Committee Code of Conduct