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 - Gladys West Elementary School
401 - FCPS Administration
402 - VFW Post 3103

Areas of Interest

Outreach
Membership
Fundraising
Get Out the Vote
Women's Caucus
Other (explain below)

Other Information?

Membership Declaration

I affirm that I:

* Am a Democrat
* Am a registered voter within the city of Fredericksburg
* Believe in the principles of the Democratic Party
* Do not intend to publicly support any candidates opposed to a Democratic nominee or FDC-endorsed candidate in the next two years

Electronic Signature *

Website

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