MEMBERSHIP FORM

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        Join the Democratic Club of Santa Maria Valley
Note:  Convenient membership and credit card payment also available                                                                             on our website with ActBlue.
Membership Application
Date____________________________________
Name___________________________________
Address_________________________________
City_____________________________________
State__________________ Zip Code__________
Telephone________________________________
Cell Phone_____________________________
Email____________________________________

Annual Membership Dues:
Individual/$20__ Couple/Family/$30__ Senior or Student/$10__

Sustaining Memberships:
Millennium * $1000 /person __      Half-Millennium  * $500 /person __
21st Century Club Member  * $210/person __
( *  In full or paid in 12 monthly payments with ActBlue.)
Century Club Member $100/person __   Half-Century  $50/person _

*Additional Donations to fund Club’s activities
$10__ $25__ $50__ $75__ $100__ Other  $___ Amount Enclosed ___________
Paid _____ Cash ____ Check ____No.____

Pay with ActBlue or Paypal link on our home page
OR mail to our headquarters in Santa Maria.

Mail application and dues to:
DCSMV
327 East Plaza Drive, Suite 2
Santa Maria, CA  93454

805-349-2708  Email:  dcsmv@dcsmv.net
Democratic Club of Santa Maria Valley PAC
CA  FPPC ID #1288725
Federal (FEC) ID COO447201
*Political donations are not tax deductible.