Member Information Annual Review
Every year, NBWDC is required to submit a verified Member Roster to the California and Orange County Democratic Party offices and to the Federal Elections Commission. Your cooperation in helping us keep the required accurate records is greatly appreciated.
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 California Fair Political Practices 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.
Programs & Events
Chair: Lori Karaguezian … Meeting & Event Planning (speakers, programs, etc.)
Chair: Tara Steele … Messaging and marketing for all electronic and printed media.
Voter & Member Outreach
Co-Chairs: Cate Hardesty & Faye Hezar … Educate & register voters; retain and recruit club members.
Co-Chairs: Faye Hezar & Lorellen Green … Plan fundraising events and activities; develop major donor relationships.
Governmental Activism
Chair: Kathleen Andrews … Monitor local, state and federal governmental bodies, issues and legislation.
Co-Chairs: Maureen Rust & Lori Karaguezian … Maintain bylaws as required by NBWDC/DPOC/CADEM policies.
Endorsements & Nominations
Co-Chairs: Beryl Smith & Nancy Geerlings … Vet candidates seeking NBWDC endorsement; develop a slate for potential NBWDC officers.
None of the above
Comments or questions?
Thank you!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy