Membership Contact Form


Because to the low cost of membership and the high cost of online payment processing we request that you please send a check (made out to the Columbia Democratic Club) to...

Columbia Democratic Club
P.O. Box 6361
Columbia, MD 21045

Please fill in all fields marked with a *
Name*
Address*
Address
City*
State*
Zip*  (Exam. 21045 or 21045-0123)
Phone*  (Exam. 410-555-1212)
Fax  (Exam. 410-555-1212)
E-mail*
Congessional District  (if known)
Legislative District  (if known)
Council District  (if known)
Election District  (if known)
Precinct  (if known)
Yearly Membership Dues* $20 Individual
$10 Senior
$10 Student
Number of Additional Family Members ($10 each)
Additional Contribution
I would like to help: (check all that apply)
Work on a fundraiser
Put up window/lawn signs
Put bumper sticker on car
Help prepare mailings
Write or sign letters to the editor
Work at the polls on Election Day
Make phone calls
Work voter registration tables
Distribute Literature
Serve on a CDC committee
Please tell us about yourself
Interests
Other
How do you want to get our Newsletter?
Newsletter* E-Mail only
Regular mail only
E-Mail and Regular Mail


              

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