Name:______________________________________________________
Email Address: [ ]____________________________________________
Street, City, ST, Zip: [ ]________________________________________
Mailing Address*: [ ]___________________________________________
*: (If different from above; please note that we need a residential address in order to determine your precinct).
Phone # [ ] home ___________ [ ] cell _____________ [ ] other __________
Please check the box(es) in front of contact information to show us the best way to contact you.
I will pledge to help our local party in the following way(s):
Have Would Wouldn’t Experience Like to Do This Want to Do
Organize my block/precinct/neighborhood [ ] [ ] [ ]
Adopt a precinct if mine is covered [ ] [ ] [ ]
Campaigning/Polling [ ] [ ] [ ]
Phone banking [ ] [ ] [ ]
Precinct walks [ ] [ ] [ ]
Attend rallies/Visibility activities [ ] [ ] [ ]
Fundraising/Special events [ ] [ ] [ ]
Leadership role in Party [ ] [ ] [ ]
Candidate/Run for office/Elected position [ ] [ ] [ ]
Candidate training [ ] [ ] [ ]
Volunteer training [ ] [ ] [ ]
Technology (describe)______________________________ [ ] [ ] [ ]
Data entry [ ] [ ] [ ]
General office skills [ ] [ ] [ ]
Other (describe)___________________________________ [ ] [ ] [ ]
Other (describe)___________________________________ [ ] [ ] [ ]
Other (describe)___________________________________ [ ] [ ] [ ]
I will pledge to volunteer for [ ] hours per week during Fall-Winter.
I will pledge to volunteer for [ ] hours per week during Spring-Summer.
I will pledge to volunteer for [ ] hours per week during Fall.
[ ] I am a new volunteer.
[ ] I volunteered recently for this activity: ____________________________.
The best times for me to volunteer are (place checks in appropriate boxes):
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[ ] I am unable to volunteer, but would like to donate to fund others’ volunteer activities to help build our local party or would like to donate in addition to volunteering.
____ $25.00 ____$50.00 ____$100.00 ____ Other $_____
I am the currently elected Democratic Party...
[ ] Chair [ ] Vice-Chair [ ] At-Large Representative ...for my
Legislative District
[ ] Man [ ] Woman [ ] Youth
…for my Precinct
Comments: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature Date