Membership ApplicationMembership is for the fiscal year ending Dec. 31 of current year Name/Organization * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### Email * Preferred Contact Method * Text Email Occupation/Profession * Political Affiliation * Democrat Republican Independent Other: Special Interests * Education Healthcare Environment Economic Development Social Justice Other: My Service Interests Area are * Candidate Endorsement Committee Economic Empowerment/Fund Distribution Watch Team Education of Voters & Non-Votes GOTV- Souls to Polls Support of & Accountability of Elected officials Creative Media/Communications Team Next Generation Interest & Involvement Team Sign Display/Distribution Membership Levels: Special rate for Initial Start Up year! -Please select your desired membership level * Individual Membership: $10 Family Membership: $25 Founding Membership Pledge: $500 Business/ Group Sponsorship -Show your business's support for our cause. Choose a level Bronze Sponsorship- Includes a mention on our website and in our newsletter: $100 Silver Sponsorship- Includes Bronze benefits plus recognition at our events: $250 Gold Sponsorship- Includes Silver benefits plus a feature spot in promotional materials: $500 Signature/Date * Thank you, your application has been received!
