360 Corridor Democratic Action!

360CDA Membership Application

Please complete the membership form below.

Submittal Date:

Precinct #:

Name:

Address:

Phone #:

Email:

Employer:

Occupation:

Recruited by:

Note: By state law, 360 Corrider Democratic Action MUST report employer and occupation information in accordance with ethics rules.

How would you like to be contacted?

Mail

Phone

I am interested in joining the following Committees:

Membership

Nomination

Issues Advocacy

Community Service

Legislative

Legal

Communications

fundraising

Voter Registration

My $25 annual dues are enclosed as:

Cash

Check

Zelle

Click Zelle for more info.

Signature (Print Name):

Date:

Signing this form indicates your agreement to subscribe to the purposes of the Organization.

Note: Once button is clicked, the form is submitted and then cleared,

The purpose of the Organization is to affect change and have a voice for all communities in proximity of Hwy 360.