NORTHERN SOLANO DEMOCRATIC CLUB
MEMBERSHIP APPLICATION
print, complete, and mail to
Northern Solano Democratic Club. PO Box 192
Fairfield, CA 94533
NAME: ________________________________ (SPOUSE) __________________________
ADDRESS: ____________________________________________________________________
(Please list the address at which you are registered to vote)
CITY: _________________________________________ ZIP: _________________________
PREFERRED PHONE: ________________________ (Spouse) ___________________________
E-MAIL: ____________________________________ (Spouse) ___________________________
*OCCUPATION/_____________________________(Spouse)_______________________
*EMPLOYER: _____________________________________(Spouse)______________
*(Occupation & employer are collected solely to comply with campaign finance reporting law and will not be divulged except as required by law. If you do not anticipate making total contributions of $100 or more to the club this year, you may leave these lines blank.)
I authorize the Northern Solano Democratic Club to add my email address(es) to the club’s mail list and acknowledge that failing to do so will prevent me from receiving any correspondence.(_____initial)
I authorize the Northern Solano Democratic Club to release my contact information to fellow club members for internal communications only. Club members are not authorized to release this information to non-members without my express permission. (_____initial)
I am interested in joining/renewing membership in the Northern Solano Democratic Club. I am a registered Democrat over 18 years of age, and I am paying my dues from personal funds only. (initial_____)
Dues are $30/calendar year, $25 for seniors, students, and others claiming financial hardship, and $50/year for couples. Sustaining membership of $60/calendar year, or $100/year for couples, will merit special recognition by the club at appropriate occasions.
Payable to Northern Solano Democratic Club, not tax-deductible.
Note: Membership is based on the calendar year and is subject to renewal January 1 each year.
Amount Paid: $__________
I wish to contribute $_____monthly_________ to the club’s candidate fund. I understand that this money will be distributed to candidates in accordance with club policy and I may not designate its contribution to any particular candidate.
I wish to make a general contribution of $______ which may be used for any lawful purpose the club deems appropriate.
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(Office use only) Dues paid: ck / cash / online Date: