APPLICATION FOR CDC MEMBERSHIP

True representation comes from building a Chesapeake Democratic Committee (CDC) that reflects the diversity of our community. We are looking for new members to share their skills and/or develop new ones by participating and working to elect more Democrats.

To apply to become a member of the CDC, please complete the following:

As a resident of Chesapeake, Virginia, I, Full Name , affirm that I am registered to vote in the Precinct NumberPrecinct in which I reside, that I promise to support the ideals of the Democratic Party, and I hereby declare myself as a Candidate for Membership with the Chesapeake Democratic Committee (CDC), submitting my dues as instructed below.

Date: Date    E-mail:E-mail address     
Address:Street Address   Address Line 2   City   State   Zip   Phone: Area Code   Phone Number   

Please complete the following information required by the Virginia State Board of Elections:
Employer:   Full Name   Your Position:   Your Title   

Please submit your annual membership dues of $25.00 with this application by clicking "Submit and Pay" button below, or mail your application and check to: Chesapeake Democratic Committee, P.O. Box 2691, Chesapeake, VA 23327-2691.  

We are pleased that you have decided to apply for membership with the Chesapeake Democratic Committee. Your application is subject to acceptance by the Chesapeake Democratic Committee.

Questions? CDC website: http://www.chesapeakedemocraticparty.com
CDC Facebook page: https://www.facebook.com/groups/264857041184/

__________________________________________________________________________________To be completed by CDC:
Dues received: yes no Received by:____________________________________________ Notes:____________________________________________________________________________
Registration verified: _____ Precinct #_____ Poll: ______________ Receipt #: ___________