VCDCC Member Form

VCDCC MEMBER FORM 2025 (Rev. 1/2025)

This form is to be completed by Elected, Ex-Officio, and Associate delegate members. For help, you may contact VCDCC.Secretary@Gmail.com.
Date*

MonthDayYear
Date
First Name *
Middle Name
Last Name*
Email Address*
example@example.com
Cell Phone
One phone number is required
Home Phone
One phone number is required
Work Phone
One phone number is required
Applicant Signature (By signing here you agree to all VCDCC Bylaws and Standing Rules, CDP Code of Conduct and VCDCC & CDP rules.)*

Clear
Voter Registration Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState

Zip Code
What gender identity do you currently identify with?*
Cisgender means you identify with your assigned gender at birth. Transgender means you identify with a different gender than your assigned gender at birth.
Do you Identify as LGBTQ+?*

YesNoPrefer not to share
If you would like more clarification, please use these resources.

https://www.transhub.org.au/101/cis

https://gaycenter.org/about/lgbtq/
Please identify your race and ethnicity*

Black / African AmericanAsian / Pacific IslanderIndigenous American / IndianLatino/a/xChicano/ChicanaWhiteNot Listed
Your Congressional District*
As of the 2023 district lines
Your State Senate District*
As of the 2023 district lines
Your State Assembly District*
As of the 2023 district lines
Your Supervisory District*
As of the 2023 district lines
Occupation*
If retired, enter "retired". If not employed, enter "not employed".
Employer*
If retired, enter "retired". If not employed, enter "not employed".
Skills
Organizational Affiliations
Committee Assignment (at least 1 assignment is required by Bylaws, check all you want to join)*

FundraisingCommunicationsField Operations (Voter Outreach & Elections)Candidate Recruitment & TrainingSocial EventsClub Development (Working Group for Club Growth)ResolutionsBudget & Financial ReviewBylaws
DEM: Have you signed up for Donate Every Month? (this is required under our bylaws) https://secure.actblue.com/donate/recurringcontribution*

YesNo
Would you like to request a financial hardship waiver for Donate Every Month?

YesNo
Alternate Voter Full Name (You may appoint one alternate)
Alternate Voter Email Address (Your alternate to the VCDCC)
example@example.com
Alternate Cell Phone (Your alternate to the VCDCC)
This form and payment shall be received a minimum of 30 minutes prior (5:55PM) to the first order of business (6:25PM) in a meeting in order to be eligible for processing your Alternate.
Do you request a financial hardship dues waiver?*

YesNo
Member Type and Dues Amount (please choose one member type and the alternate fee): https://secure.actblue.com/donate/membershipfees*

Elected Supervisory District Member- $25ADEM Delegate - $25Ex-Officio - $25District Director - $25Alternate - $5Club Representative- No FeeDSCC Member - $25 (Provide which district)DSCC Appointed Delegate - $25 (Provide which district)
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