2026 Hampton Dems Membership application

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First Name:
*

Last name: *

Street address: *

City, state, and Zip code: *

email:

Phone number:

Please indicate the best way to contact you: *

Phone call to number bove

Mail

text to phone number above

Employer: (required by VA Department of Elections) *

Occupation: *

Please respond to the following: By my signature below, I certify that I an a resident of the city of Hampton and I'm registered to vote. I will not support a candidate opposed to any candidate nominated or endorsed by the Democratic Party during my tenure on the Hampton Democratic Committee. (Please type your full name below); *

You may submit payment of $25 for annual membership dues by: *

mailing a check to Hampton Democrats, P O Box 342, Hampton VA 23669

I request a waiver of dues because of financial hardship

online at https://secure.actblue.com/donate/hamptondems2026

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