Membership Declaration Form for 2011 Term
Gloucester Democratic Committee of The Democratic Party of Virginia
In accordance with Section 2.1 of the Virginia Democratic Party Plan, a
resident of the Commonwealth of Virginia who believes in the principles
of the Democratic Party is hereby declared to be a member of the
Democratic Party of Virginia. To participate with full membership
privileges in the Gloucester County Democratic Committee, each person
shall sign a standardized declaration form stating that he or she is a
DEMOCRAT, does not intend to support any candidate who is opposed to a
Democratic nominee in elections during this period, is not a member of
any other political party, and is a registered voter in the Gloucester
County Election Precinct of the County of Gloucester, Virginia, as
indicated below.
I hereby declare my candidacy for membership in the Gloucester County
Democratic Committee as a representative from
_________________________________________________ Precinct, and attest:
- I am a DEMOCRAT and believe in the principles of the DEMOCRATIC
PARTY.
- I do not intend to support any candidate opposed to a DEMOCRATIC
NOMINEE in the ensuing elections.
- I am a bona fide resident and a current registered voter in the
precinct I seek to represent.
Signature:
Date:
/
/
PLEASE PRINT THE FOLLOWING INFORMATION:
Name:
Street
Address:
Mailing Address if
Different:
City:
, VA
Zip:
Telephone:
E-mail:
Note: Year 2010 dues are $20.00. Make check
payable to: GCDC.
Mail
to:
Joseph Crandel, GCDC Treasurer
2005 Tillage Lane
Hayes, VA 23072
Contributions to the Democratic Party are not tax deductible.
Authorized and paid for by the Gloucester County Democratic Committee.
Gloucester County Democratic Committee