Membership Application Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Precinct *

101 - Hugh Mercer Elementary
201 - Dorothy Hart Community Center
301 - Walker-Grant Middle School
401 - New City Fellowship Church
402 - VFW Post 3103

Areas of Interest

Membership
Outreach
Fundraising
GOTV
Women's Caucus

Other Information?

Membership Declaration

I am a Democrat, I believe in the principles of the Democratic Party, and I will not support any candidate opposed to a Democratic nominee as long as I am a member of the Committee. I am a resident and registered voter in the City of Fredericksburg.

Electronic Signature *

Website

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Not authorized by any candidate or candidate’s committee.

Credits

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