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 requiredFormat: (000) 000-0000.
Home Phone
One phone number is requiredFormat: (000) 000-0000.
Work Phone
One phone number is requiredFormat: (000) 000-0000.
Applicant Signature (By signing here you agree to all VCDCC Bylaws and Standing Rules, CDP Code of Conduct and VCDCC & CDP rules.)*
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)
Format: (000) 000-0000.
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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