Rural Caucus - DPVA 2026 Membership Application
Become a member by completing this form. The Rural Caucus has a suggested donation of $20 that you can pay by clicking this ActBlue link, https://secure.actblue.com/donate/ruralcaucusmember. You can also print this form and mail it along with a donation made payable to Rural Caucus - DPVA to P. O. Box 1112, Berryville, VA 22611.
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Email *
First and Last Name *
Address *
City and Zip Code *
Phone Number (Land and/or Cell) *
County/City of Residence *
Congressional District *
By agreeing below, I am affirming that I: am a Democrat; am registered to vote in the Commonwealth of Virginia; believe in the principles of the Democratic Party; and do not intend to support any candidate who is opposed to a Democratic nominee in the next ensuing election.
 *
Signature and Date *
A copy of your responses will be emailed to the address you provided.
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