Gold Member Enrollment Form

We appreciate your dedicated support for our local party now and in the future. With your help, we will continue to reshape the political landscape and decisively turn the Western Slope blue!

Please complete this form to become our newest Gold Member. If you need help or have any questions, please email us at finance@montrosedemocrats.org.

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

E-mail Address

Recurring invoices will be sent to this address

Referred By

Campaign Finance Legal Requirements

State law requires political parties to report the name and mailing address for each individual whose contributions are $20 or more per calendar year. Occupation and name of employer is also required when contributions are $100 or more in a calendar year. The value of your donation is not tax-deductible as a charitable contribution for federal income tax purposes. We cannot accept donations from corporations or unions.

The following information is required by campaign finance laws:

Name of Employer*

If you are not employed, please type NONE in this box.

Occupation*

If you are not employed, please type NONE in this box. If you are retired, please type RETIRED in this box.

LEGAL COMPLIANCE STATEMENT*

I confirm that the following statements are true and accurate:

I am not a foreign national who lacks permanent residence in the United States.
I am not a Federal government contractor.
This contribution is made from my own funds, and not those of another.
This contribution is not made from the funds of a corporation or labor organization.
This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person.
I am at least eighteen years old.

How do you want your name(s) to appear on the website?*

Type NONE to remain anonymous

Are you a registered voter in Montrose County?*

YesNo

Your membership includes two t-shirts. Please indicate the sizes you want.

Shirt Size #1

Shirt Size #2

Your membership includes up to two name tags. How do you want them to appear?

Name Tag #1

Your name tag

Name Tag #2

Spouse or partner's name tag

Payment Type*

Payment by Mail — I will send a check or call to set up ACHOnline Payment (fill out below)

ONLINE PAYMENT

Monthly Payment$20.00

Annual Payment$240.00

Total $0.00

Credit Card Details

Comments:

Please provide any other information you want us to know about this enrollment.

If you encounter any problems with this form, please contact Kim Floyde for assistance.

We appreciate your dedicated support for our local party now and in the future. With your help, we will continue to reshape the political landscape and decisively turn the Western Slope blue!

Please complete this form to become our newest Gold Member. If you need help or have any questions, please email us at finance@montrosedemocrats.org.

Campaign Finance Legal Requirements

Credit Card Details