SAN DIEGO DEMOCRATS FOR DISABILITY RIGHTS

MEMBERSHIP FORM

Club membership is open to all registered Democrats who support the principles of the Democratic Party (as stated in the Democratic platform), regardless of race, religion, national origin, gender, dis/ability or sexual orientation.

Contributions are not tax deductible for federal income tax purposes. Federal law requires political committees to report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Dues are subject to Federal prohibitions and limitations for Federal elections. Club dues for the year 2004 are payable by immediately. Membership is required in order to vote at Club meetings.

Membership Dues:  r Check here if you are requesting a Membership Dues Waiver
Hardship	$5.00	Regular Member	$10.00	Sponsor	$25.00
Supporter	$15.00	Benefactor	$50.00 or more

Please complete this form and mail with a check or money order:

NAME

ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBERS (please indicate area code and number)
HOME

WORK

FAX

MOBILE

TTY

E-MAIL ADDRESS

OCCUPATION

Type of Membership (please check one):  r Dues Waiver (please waive my membership dues due to financial hardship or limitations)   r Hardship $5.00    r Member $10.00
r Supporter $15.00    r Sponsor $25.00    r Benefactor $50.00 or more
Amount Enclosed:
$
Signature:
My signature above certifies me as a registered Democrat OR my expressed intent to register as a Democrat.









Please include a check or money order made payable to "San Diego Democrats for Disability Rights" and mail this form in an envelope to protect your privacy to:


San Diego Democrats for Disability Rights
c/o John Johnson
6161 El Cajon Blvd., #418
San Diego, CA 92115

THANK YOU FOR YOUR MEMBERSHIP,
CONTRIBUTION AND SUPPORT!