Membership Application
*Please
indicate: () new member, () renewal, () update information (*Required Information)
*NAME:
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EMAIL & PHONE:
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*ADDRESS:
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*EMPLOYER & OCCUPATION:
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COUNTY:
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CHAPTER:
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CONGRESSIONAL/SENATE/HOUSE
DISTRICTS:
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ELECTED/APPOINTED OFFICES:
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MEMBERSHIP
LEVEL (check one)
() - Finance Council: $1000+
() - Finance Council: $500
()
- Finance Council: $250
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()- Finance Council: $120
() - Patron: $50
() - Sustaining: $25
() - REGULAR: $20 |
Treasurers' use only:
___________
date dues accepted |
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| 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, the membership directory, 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 and the membership
directory. |
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, either make check payable to Texas Democratic
Women or provide credit card information below (*indicate amount paying
$_______)
Account Number:
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()MasterCard or ()Visa
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Signature & Date:
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Expiration(Month/Year)____/____
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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.
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