Name (as registered to vote, if registered)
*
First Name
Last Name
Email
*
example@example.com
Registered Voting Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City of Residence
*
City
Phone Number
*
Please enter a valid phone number.
County of Residence
*
Santa Clara County
Alameda County
San Mateo County
San Francisco County
Contra Costa County
Other
Are you a registered Democrat?
*
Yes
No, but I am willing to register as one
No
Age
*
Under 18
18-25
26-34
35-54
55-74
75 or older
Religious Affiliation (If Any)
*
Christian
Jewish
Muslim
Hindu
Non Religious
Prefer Not to Answer
Other
Would you like to purchase a membership today?
*
Yes
Not today
If so, what type?
prev
next
( X )
Membership
$
35
Type
Individual
Family
Student
Would you like to participate?
*
I would like to organize/lead/run/volunteer
I don't have time to help right now
What are you most interested to work on? Or let us know anything else you want us to know (such as skills that you have to offer)
Tell us anything you'd like us to know
Please verify that you are human
*
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