DEMOCRATIC WOMEN'S CLUB OF LEE COUNTY

Membership Application

NAME: ______________________________________________      Date: _____________________

ADDRESS: ___________________________________________      Apt. # ____________________

CITY: _______________________________________________      STATE: ____ ZIP: ___________

HOME PHONE: (___)________________  Best time to call: __________________________________

FAX: (____) ________________ E-MAIL: _______________________________________________

SPOUSE: _____________________________   NAMES of CHILDREN (include AGE or write ADULT

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Voter Registration #: ____________________                    PRECINCT #: ________________________

County Commission District: ______________                    State SENATE District: _________________

CONGRESSIONAL District: _____________                    State HOUSE District:  _________________

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I have experience with an/or would be interested in helping on the following committee(s):

By-Laws ___    Historian ___    Legislature ___    Outreach ___     Sunshine ___

Campaign ___   Hospitality___   Membership ___ Program ___      Telephone ___

Fundraising ___ Issues ___        Newsletter ___     Scholarship ___

Are you willing to serve as an officer?       YES        NO   (circle one)    

What kind of work are/were you involved with? ______________________________________________

What clubs/organizations and/or volunteer activities are you associated with? (Use the back if necessary.)

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What do you feel is the most important topic that Democratic women should focus on -- and/or give program

suggestions: __________________________________________________________________________

QUESTIONS/COMMENTS: __________________________________________________________

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MEMBERSHIP: $25.00 Annually (January -- December)  Please make your check payable to:

Democratic Women's Club of Lee County

P.O. Box 07117

Fort Myers, FL 33919