Membership
	How to Apply
	Online Application

STEP 1: Login Information
*E-Mail:	*Password:       *Confirm: (between 5 - 15 characters)
Password Reminder: [select a question to answer] What's your birthdate (mm/dd/yyyy)? In which city were your born? What was your highschool nick-name?	Answer:
STEP 2: Personal Information
Title:     *First:             Mid: *Last: Mr. Ms.	Suffix:
*Address:                     *City:	*State:        *Zip:
*Phone:                         Fax:
STEP 3: Professional Information
Company:                   Department:                 Title:
Address:                       City:	State:        Zip:
Phone:                         Fax:
STEP 4: Membership Details
Send Written Materials: To Work To Home Subscribe to Email?:      No Yes I am applying as a:      Sustaining Member ($50/yr) Sponsoring Member ($40/yr) Regular Member ($30/yr) Reduced Rate Member ($15/yr)
What are your particular interests or areas of expertise? (255 chars max) Please list other community or political groups you belong to: (255 chars max)
How did you hear about us?
Are you a voting member of any other political club?      No Yes

© 2006 The Village Reform Democratic Club