Heartland Community Young Democrats
Membership Application for Heartland Young Dems!!
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First and Last Name *
What is your age? *
This helps us understand the diversity and demographic information for our membership!
What are your pronouns? *
How do you identify?
Email address *
Email is our primary method of contact for upcoming events, meetings and important messages from the Executive Committee. Your email will not be viewed or shared by anyone outside the HCYD Executive Committee.
Phone number
You may choose to also add your cell phone number for other communication purposes. Your cell number will not be viewed or shared by anyone outside of the HCYD Executive Committee. 
Would you be interested in volunteer service? *
If yes, what type of volunteer service would you like to do?
By selecting the “I agree” box, you are agreeing to becoming an “Active” member of the Heartland Community Young Democrats AND also agree and understand that annual membership dues of $20 will be due. The $20 membership dues can be given to our Treasurer in Cash or Check payments only. Checks may be written out to “HCYD”. Thank you! *
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