MDP Rural Caucus Membership Form
No membership fee is required to join.
However, our work to advocate for Michigan’s rural families and communities is funded solely by donations. We accept donations through ActBlue (link below) or check made out to MDP Rural Caucus P.O. Box 225, Manistee, MI 49660.
Please consider a monthly donation through Act Blue
Mdpruralcaucus.com
https://secure.actblue.com/donate/michigan-democratic-party-rural-caucus-1
https://www.facebook.com/groups/ruraldemscaucusmi/
Date
MM
/
DD
/
YYYY
Name
Your answer
Email
Your answer
Phone
Your answer
Address
Your answer
City, State
Your answer
County
Your answer
Zip
Your answer
Michigan Democratic Party Member
Yes
No
I'm not sure
Clear selection
Community Affiliations/memberships
Your answer
Age Group
16-26
27-40
41-55
56-70
71+
Clear selection
What issues/policies are most important to you?
Your answer
Skills/expertise/experiences that you are willing to share
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms