Bexar County Democratic Women Membership Application

Please indicate: (_)new member, (_)renewal, (_)update information

*NAME______________________________________________________
*ADDRESS___________________________________________________
PHONE_______________________  EMAIL________________________
COUNTY___________________  CHAPTER:  Bexar County Democratic Women
CONGRESSIONAL/SENATE/HOUSE Dist._____/_____/_____
ELECTED/APPOINTED OFFICES________________________________
*EMPLOYER ________________________________________________ 
*OCCUPATION_______________________________________________
*Required Information

Membership Level:  (_)Regular-$25, (_)Sustaining-$30, (_)Patron-$55, (_)Finance Council-$125+

Make check payable to Bexar County Democratic Women and mail to:  Bexar County Democratic Women, c/o Dick Waits - BCDW Treasurer, 4234 Shadow Elm Woods, San Antonio, TX 78249-2042.  $15 from each membership is retained by the chapter.  Please indicate the membership level on your check, and also if you are making a donation to BCDW in addition to your dues. (Example:  Regular + $50 to BCDW)

VERIFICATION   *By my signature below, I certify I am a Democrat who supports the increased political activity and influence of Democratic women in Texas politics and government, I am over 18 years of age, and I am not a foreign-born national.

_____________________________________________________________________
Signature and Date