D0OWN LOAD A COPY AND MAIL TO:

MATHEWS DEMOCRATIC CMT. POBOX 1111, MATHEWS VA. 23109

Mathews County Democratic Committee

                           Membership Form

 

I, the undersigned, hereby state that I am a Democrat, I am a registered voter in Mathews County as listed below, that I believe in the principles of the Democratic Party, and I do not intend to support any candidate who is opposed to a Democratic nominee in the next ensuing election.

 

PLEASE PRINT:

 

Name

Address

City / State/Zip

Phone Number

work:

home:

cell:

Fax Number

Email Address (non-government)

Congressional District:

First CD, 98 th State House, 6th State Senate

City or County:

Mathews County


New Membership


Renewing Membership

 

 

 

 

 

Signature   ______________________________________________ Date __________________

 

 

Secretary Notes:

 

Date Elected: _______________           Excel: ______________       VAN: _____________

 

 

 

 

 

 

 

Paid for and Authorized by the Mathews County Democratic Party