Annual Enrollment Form
Use this form to register yourself as a member of the Democratic Party of Benton County (DPBC).

Membership with the DPBC is renewed each year. 

There are no dues/costs to be a member. 

You will be provided the link to our ActBlue page after completing your enrollment if you wish to set up a one-time or recurring donation to support the efforts of the DPBC. 

At the DPBC we value contributions of time, talent, and treasure - or any combination.


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Email *
Contact Information
Please complete the following fields for our records.  
What is your legal first name? *
What is your legal last name? *
What is your preferred name?  *
What is a good phone number that we can call or text you on? *
Telephone Number Opt In Disclosure:  
By providing your phone number, you agree to receive text messages from the Democratic Party of Benton County. Message & data rates may apply. Message frequency varies. Reply STOP to opt-out, reply HELP for help.
Mailing Address
Mailing Street Address (123 Main Street) *
Mailing City *
Mailing Zip Code *
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