High Desert Progressive Democrats Membership Application (Mar. 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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.

Registered County of Residence *

San Bernardino

Other:

Board of Supervisors District *

San Bernardino BOS 1

San Bernardino BOS 3

Other:

Assembly District *

Other:

Senate District *

Other:

Congressional District *

Other

Prefix

Ms.

Mrs.

Mr.

Dr.

Hon.

Other:

Clear selection

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) *

Known By Name (if different from Voter Registration)

Registered Address *

City *

State *

Other:

Zip Code *

Phone Number(s) (999-999-9999 format please) *

Email Address *

Birthdate (XX/XX/XXXX)

YYYY

Gender *

Female

Male

Prefer not to say

Other:

Comments (if any):

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms