Michelle Obama Community Democratic Club Membership Application.

First name

Last name

Address

Email

must be a working email where you can receive notifications.

Phone

best contact number

Employer Phone

Current Employment Company info

Are you a member of any Organization

Yes

No

list any current or past organization affiliations

If YES, which one(s)

Are you currently or a past member of another political club

YES

NO

do you have any political affiliations past or present.

If YES, which one(s)

list any past or present political club affiliations

If other please list here

Which times works best for you

9am-12pm

12pm-3pm

3pm-6pm

6pm-9pm

select all that apply

What committee(s) would you be interested in serving on

Fundraising Committee

Community Organizing Committee

Social Media Committee

Youth Leadership & Education Committee

Membership & Volunteer Committee

Events & Programming Committee

Political Action & Civic Engagement Committee

select all tha apply

Were you invited by a member of the Club to join?

YES

NO

If YES, please provide the name of who invited you?

Name the club member who invited you to join

If NO, please provide how did you hear about us.

provide how you heard about the club membership

Join the Michelle Obama Community Democratic Club Today