Haitian American Democratic Club of Broward Membership Application
Our Mission: To empower, educate, inform and engage the community in the democratic process to enhance the Democratic Party.
Voter's type:
Member (Voting)
Associate (Non-Voting)
Contact Information:
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member's E-mail
*
example@example.com
Mobile Number
*
Voter's Information:
County of Voter’s Registration
Voter's ID
Precinct
Are you a Broward Democratic Party DEC member?
Yes
No
Additional Comments/Issues of Interest/Reasons you want to be a member
I hereby confirm the information above is true to the best of my knowledge.
Please Sign Here
Regular yearly membership registration $25.00. Make checks payable to: Haitian American Democratic Club.
*
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HADC of Broward Membership
Renews automatically
$
25.00
for each
year
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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