Membership Form 2025-2026

MEMBERSHIP FORM

2025-2026

Welcome to "The 23rd SENATORIAL DISTRICT TEJANO DEMOCRATS"

Deep In The Heart of Texas!

Please complete the following information, especially your name, as it is on your Voter Registration Certificate. The Voter Registration I.D. must be correct so as to match with the voter database: Please ensure you have provided the information from your voter certificate.

Name (First, Middle, Last)*

Home Address*

City/State/Zip Code*

E mail*

example@example.com

Date of Birth *Required if you do not have or know your Voter Registration Number below.*

Date

State Senate District #

Precinct #

County

Voter Registration Number

$15.00 State Regular Membership Dues: (August 1, 2025 - July 31, 2026) $5.00 Local Chapter Membership Dues: (August 1, 2025 - July 31, 2026)

Add our Email, the23rdsdtd@gmail.com as Recipient to your Zelle bank or your Zelle phone standalone app account to securely send your membership dues. In the Message Field, enter Your Name and Membership Dues. If you use your Zelle phone standalone app and receive an error, then login to your bank website and send your membership dues via Zelle. Or mail your membership dues to the address below. Email us and let us know you are mailing a check instead. Or using Cash App, our code is $23rdsttd to make payment.

TEC Required Occupation*

TEC Required Employer*

Signature: (required)

*Note: A convenience fee is applied for credit cards payments from our credit card company. Membership dues are non-refundable. Mail the completed application and check to our address: The 23rd Senatorial District Tejano Democrats c/o David Pérez Hurley, Treasurer P.O. Box 226534 Dallas, Texas 75222-653434

Signature

My Products

2025-202 Membership($20.00 + $1.19 Convenience Fee=$21.19)

$21.19 Quantity
Item subtotal:$0.00

Product Name

$ Free Quantity

Total

$0.00

Payment Methods

Credit Card

Cash App Pay