SELECT YOUR LEVEL OF MEMBERSHIP
VOTING MEMBERSHIP: Registered
Florida Democrats that live in Volusia or Flagler County and support the
objectives of the organization.
_____ $20 Individual _____ $30 Couple (Must reside at same address)
NON VOTING ASSOCIATE MEMBERSHIP: Registered Florida Democrats who live
outside Volusia and Flagler Counties and support the objectives of the
organization.
_____ $20 Individual _____ $30 Couple (Must reside at same address)
FULL-TIME STUDENT MEMBERSHIP: Registered Florida Democrats that are full
time students and support the objectives of the organization. Must be a
registered Volusia or Flagler County voter.
_____ $10 Individual
Applicant Name
#1_____________________________________________________________
Applicant Name
#2_____________________________________________________________
Address______________________________________________________________________
City
_______________________________________________ Zip_____________________
Phone
________________________________
E-Mail________________________________
Precinct # _____________________________
(Memberships, contributions or gifts
to the Volusia Flagler GLBT Democratic Club are not deductible for federal
income tax purposes)
Mail this form to Stonewall Dems V&F, Box 1741, Daytona Beach, FL
32115-1741