DWC Membership Form - Democrats of Indian River

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Full-year or Seasonal resident?*

Primary Phone Number*

Primary Phone Number Type*

Secondary Phone Number

Secondary Phone Number Type

Email*

Signature*

(By signing, you are confirming that you are a registered Democrat.)

Date

Get Involved

Please check the areas in which you would like to be involved.

Dues cover from Jan 1- Dec 31
Please send checks to:
Barbara Spelman, DWC Treasurer
P.O. Box 651144, Vero Beach, FL 32965

Annual Membership Dues*

Price: $25.00

Payment Option*

Total

$0.00

Phone

This field is for validation purposes and should be left unchanged.