Membership Application
*Please indicate: () new member, () renewal, () update information (*Required Information) 
*NAME:

 EMAIL & PHONE:
*ADDRESS:

 *EMPLOYER & OCCUPATION:
COUNTY:
 CHAPTER:
CONGRESSIONAL/SENATE/HOUSE DISTRICTS:

 ELECTED/APPOINTED OFFICES:
MEMBERSHIP LEVEL (check one)
() - Finance Council: $1000+
() - Finance Council: $500
() - Finance Council: $250
 ()- Finance Council: $120
() - Patron: $50
() - Sustaining: $25
() - REGULAR: $20
Treasurers' use only:
___________
date dues accepted
All membership levels include annual dues for the National Federation of Democratic Women, the Texas Democratic Women, and your local TDW chapter plus quarterly issues of the TDW newsletter, The Connection.  $10 from each membership is retained by the local chapter.  FINANCE COUNCIL – in addition to the above, Finance Council members receive a gold TDW lapel pin and recognition and reserved seating at the annual awards dinner. Finance Council members may be individuals, clubs, or organizations.  PATRON - in addition to the above, Patron members receive a blue TDW lapel pin.
PAYMENT INFORMATION   
() - To pay through your local chapter, make checks payable to the chapter and provide check and this form to the chapter treasurer.
() - To pay TDW directly via check, make check payable to Texas Democratic Women.
() - To pay by credit card, go to www.actblue.com/page/tdwmembership.

Mail payment and this completed membership form either to your local chapter or to Texas Democratic Women, PO Box 2211 , Austin, TX, 78768-2211
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 and I am a citizen or legal resident of the United States.  I understand that Texas Democratic Women is a General Purpose Political Action Committee (GPAC).
Signature and Date_____________________________________________
Texas Ethics Commission requirements - money earned by TDW may be used for political purposes.