Texas Democratic Women of the Brazos Valley

2008 Membership Form

 

         Check your membership level:

      Regular Membership                                 $ 25___

      Wildflower Membership                            $ 50___

                   Ann Richards Membership                       $100___

       Bluebonnet Membership                           $250___

       Ladybird Johnson Membership                  $500___

       Student/Senior Membership                       $ 15___

 

 

Name: _____________________________________________________________

 

Address: ___________________________________________________________

 

City: ___________________________   State: _______   Zip: ________________

 

Precinct: ________ (Check your voter registration card.)                                           

 

Email address: _______________________________________________________

 

Home phone: ______________________ Cell phone: _______________________

 

Occupation: _________________________________________________________

 

*I would like to enclose an additional $ _________ for the TDW Annual Scholarship Fund.

 

Total Enclosed:  $ _________________       

($10 of every membership goes to TDW of Texas.) 

 

Please make check payable to TDW and mail to:

TDW

P.O. Box 4568

Bryan, TX 77805