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SCDC Membership Filing Form
This form will be used to file to be a member of the Surry County Democratic Committee
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Voting Address
*
The address where you are registered to vote.
Your answer
City
*
Your answer
Zip
*
Your answer
Phone
*
Please enter the number in the following format: 1234567890
Your answer
Email
*
Please confirm the email address you entered above.
Your answer
Gender
*
Please select one
Female
Male
Non-Binary
Other:
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