DWD Membership Form

Membership Levels:

Individual - $30

Family - $45

Youth (under 30) - $15

Lifetime - $250

Lifetime Family - $300

Full Name*

First NameLast Name
Is this a new membership or a renewal?

NewRenewal
Family Membership - the name of your partner/spouse

First NameLast Name
Are you registered as a Democrat in California?*

YesNoRegistered in other state (Associate, non-voting member)Not a Democrat (Associate, non-voting member)
For Renewals: Has any of your contact information changed recently?

YesNo
Registration Address if different from Mailing Address:

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
E-mail address
Do you wish to receive (OPT-IN) meeting notices and other information for members via E-mail?

YesNo
The success of DWD depends on your active participation. Please indicate which committees you might be willing to join:
Do you have other skills to offer or areas of interest where you are willing to assist, e.g. Website/Computer, Photography/Graphics, Phone Call/Texting, Voter Canvassing, Voter Registration? Please specify:
Thank you for your support!
Contributions to Democratic Women of the Desert are not deductible for income tax purposes. FPPC#1278348
Should be Empty:

Member Information