July 29, 2010
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New Member     Renewal
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Name:
Address:
City:       Zip:          Telephone:
Email Address:
(Important- most of our member contact via email, your email will be kept private and will never be used for anything beyond club contact.)
Date of Birth:
Are you registered as a Democrat in the State of Florida?*  
Are you between the ages of 21 - 41?*
I am not registered as a a Democrat in the State of Florida, or do not meet your age requirment, but i wish to become and Affiliate of the Sarasota-Manaree Young Democrats.
If you have skills or intersts that you would like to contribute, please describe them:
How did you hear about the Sarasota-Mantee Young Democrats?
Referred by:
By signing below, I affirm that I wish to become a Member or Affiliate of the Sarasota-Mantee Young Democrats. Enclosed in my payment of $35* for one year of dues. I would also like to include an additional donation of $   to further help fund the programs and mission of the Sarasota-Mantee Young Democrats.

*Please notes that dues are required within one month of joining.

If you are submitting this form on-line, please mail you dues check separately or bring to the next event. The mailing address is:  Sarasota-Manatee Young Democrats, PO Box 19811, Sarasota, FL, 34276. THANK YOU