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DEMOCRATIC WOMEN'S CLUB OF LEE COUNTY

Membership Application

NAME: ______________________________________________      Date: _____________________

ADDRESS: ___________________________________________      Apt. # ____________________

CITY: _______________________________________________      STATE: ____ ZIP: ___________

HOME PHONE: (___)________________  Best time to call: __________________________________

CELL: (____) ________________ E-MAIL: _______________________________________________

SPOUSE: _____________________________   CHILDREN: _________________________________  

__________________________________________________________________________________

Voter Registration #: ____________________                    PRECINCT #: ________________________

County Commission District: ______________                    State SENATE District: _________________

CONGRESSIONAL District: _____________                    State HOUSE District:  _________________

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I have experience with an/or would be interested in helping on the following committee(s):

By-Laws ___    Historian ___    Legislature ___       Sunshine ___  Campaign ___

Web Site Assist___   Membership ___ Program ___      Telephone ___

Fundraising ___ Issues ___        Newsletter ___     Mentorship Program ___  

What kind of work are/were you involved in? ______________________________________________

What clubs/organizations and/or volunteer activities are you associated with? (Use the back if necessary.)

___________________________________________________________________________________

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What do you feel is the most important topic that Democratic women should focus on -- and/or give program

suggestions: __________________________________________________________________________

QUESTIONS/COMMENTS: __________________________________________________________

I hereby acknowledge that I am registered with the Elections Office as a Democrat in the State of Florida:

  ___________________________________ (signature) ____________________________ (date)

___________________________________________________________________________________

MEMBERSHIP: $30.00 Annually (January -- December)  Please make your check payable to:

Democratic Women's Club of Lee County

P.O. Box 07117

Fort Myers, FL 33919

Your contact information must be shared with the DWC of Florida.
If you would prefer that your contact information not be shared,
with other members, please initial here: ______________