HAMPSHIRE COUNTY DEMOCRATIC CLUB
P.O. Box 476
Augusta, WV 26704
MEMBERSHIP APPLICATION
Membership is open to Hampshire County registered Democrats, without limitation, upon payment of their annual dues. Associate membership, without voting privileges, is open to all persons, 16 years of age or older, upon payment of their annual dues.
Annual Dues Schedule (please check type of membership desired)
____ Single Membership $20.00
____ Household Membership $30.00 (submit
a form for each person)
____ Associate Membership $10.00
Name ________________________________________________________________________
Mailing Address_________________________________________________________________
City ___________________________ State _____________ Zip Code______________
Voting Precinct Number ___________ Polling Location _____________________
Phone ____________(home)____________(work) _____________(cell) Email__________________
Please print out form, complete, and mail with your check for dues payable to Hampshire County Democratic Club, P.O. Box 476, Augusta, WV 26704.
Hampshire County Democrats 