Membership Form

37th District Democrats Membership Form

Please print this form from your browser and return with your payment to the address below.

Choose a membership level:

Individual memberships
 Regular Membership ($37)
 Gold Membership ($100)
 Emerald Membership ($300)
 Limited Income Membership ($15)
Two or more persons in the same household
 Family Membership ($65)
 Family Gold Membership ($175)

Name(s): _________________________________________________________________________________________

_________________________________________________________________________________________
(Please list all household names joining if membership is for a Family, Sponsor, Gold, or Emerald membership.)

Phone(s): ___________________________________________

Address: _________________________________________________________________________________________

_________________________________________________________________________________________

Zip: ______________________________________________

Email address(es): _____________________________________

Occupation(s): ____________________________________________________________

Employer’s Cities: _________________________________________________________

Employer’s State(s): ________________________________________________________

Print and return this form to:
37th District Democrats
P.O. Box 28306, Seattle, WA  98118
NOTE: make checks payable to 37th District Democrats