Democratic Women's Club of Upper Pinellas Membership Application
This completed application is required for DWCUP membership. Club dues may be paid in Step 2 under Membership  after you fill this form out.
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Email *
Club Dues:  $25.00 per year;  Silver 3 years = $70.00;  Gold 5 years = $100.00;  Sapphire Forever Member = $250.00
First Name *
Last Name *
Street Address *
City *
Zip Code *
Date of Birth - or - Voter Registration ID Number *
Mobile Number (Preferred)
Landline Number (if only phone)
Text Reminders
Can DWCUP send you text reminders for meetings? *
Club Dues:  $25.00 per year;  Silver 3 years = $70.00;  Gold 5 years = $100.00;  Sapphire Forever Member = $250.00
Pay Dues online through ActBlue in Step 2 under Membership tab
Payment *
Pay Dues by Check: Made out to DWCUP
Mail to
Kathleen Keohane
2814 Landover Dr.
Clearwater, FL 33761
LOYALTY OATH
I hereby certify that I am a member of the Democratic Party of Florida who supports active involvement and influence of citizens in politics and government affairs in Pinellas County, the State of Florida and the United States of America.  
Type your FULL NAME IN THE SPACE BELOW THE BOX.
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A copy of your responses will be emailed to the address you provided.
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