Member/Donor Required Information
NBWDC is required to submit a verified donor/member report to the Federal Elections Commission each quarter.  The information below ensures we remain in compliance with the FEC, avoiding penalties and fines. Your cooperation in helping us keep the required accurate records is greatly appreciated.

If you recently made donation by credit or debit card, thank you!  Your transaction receipt was emailed to you. Or you may log into your credit card processing account to view the transaction details.
Sign in to Google to save your progress. Learn more
First Name *
Name is it appears on Voter Registration Records
Last Name *
Name is it appears on Voter Registration Records
Email Address *
Email Permission *
May we add you to our Email Newsletter list?
Political Party Affiliation *
Select the party affiliation that matches your Voter Registration record
Home Club *
Do you consider NBWDC as your primary Democratic Club?  
Who referred you/how did you find us? *
Let us know if there is someone we can thank for your referral. Include their name in OTHER below.
The Federal Elections Commission requires NBWDC to maintain the following information for all our dues-paying members.  
Occupation *
Enter Occupation or "Retired"  
Employer/Business Name *
(If employed, enter Employer Name,  If self-employed enter Business Name; if "Retired" enter NONE)
Please provide your phone number(s)
Primary Phone #
Please include Area Code (eg:  111-111-1111)
Primary Phone Type
Clear selection
Secondary Phone #
Please include Area Code (eg:  111-111-1111)
Secondary Phone Type
Clear selection
Permission to Text
May we text you with event news and updates?
Clear selection
Address Information
Current Street Address *
Street #, Street Name, Unit # if applicable
Current Zip Code *
Is the above address the same as your . . . *
Mailing Address
Voter Registration Address
If you answered NO in the above question, please include the other address(s) here:
Street #, Street Name, Unit #, Zip
Select one or more Committees on which you will serve.
1. Programs/Events: Meeting & Event Planning for speakers, topics, activities
2. Communications: Messaging and marketing for newsletters, emails, social media
3. Field Operations/Voter Outreach: Postcarding, Text/Phone Banks, Canvassing etc.
4. Membership: Develop recruit efforts and programs to retain members
5. Government Activism: Monitor/report on local/state/federal governments, issues/legislation
6. Fundraising: Plan fundraising events/activities and develop donor relationships
7. Endorsements & Nominations: Research candidates seeking endorsement or for NBWDC office
8. Bylaws: Maintain bylaws as required by NBWDC/DPOC/CADEM policies
Programs & Events
Voter & Member Outreach
Governmental Activism
Endorsements & Nominations
None of the above
Comments or questions?
Thank you!
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy