High Desert Progressive Democrats Membership Application (Mar. 2022 - Feb. 2023)
To become a member, please complete this form and then pay the $20 annual dues at https://secure.actblue.com/donate/hdpdmember22-23 or mail a check in that amount to High Desert Progressive Democrats to PO Box 1985, Victorville, CA 92395. Membership is effective 60 days after receipt of dues or at the next regularly scheduled meeting. Hardship waivers are available to those who need them. If you would like to submit a request for a hardship waiver, please put that request in writing by emailing us at info@hdprogressivedemocrats.org.
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Registered County of Residence *
Board of Supervisors District *
Assembly District *
Senate District *
Congressional District *
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First name (as it appears on Voter Registration) *
Middle Name or Initial, if any (as it appears on Voter Registration)
Last name (as it appears on Voter Registration) *
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Registered Address *
City *
State *
Zip Code *
Phone Number(s) (999-999-9999 format please) *
Email Address *
Birthdate (XX/XX/XXXX)
Gender *
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