DEMOCRATS OF HILL COUNTY
P.
O. BOX 285, HILLSBORO TX 76645
Membership year runs
September 1 through August 31. Dues paid
after May rollover to the following year.
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Individual
$20.00
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Couple $30.00
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Finance
Supporter $50 $100
$150 $200 $250
$500 $1,000
Name_______________________________________________________________________________
Spouse’s Name
______________________________________________________________________
Physical Address ____________________________________________________________________
Mailing Address _____________________________________________________________________
City
____________________________________________________ Zip________________________
Email ______________________________________________________________________________
Spouse’s
email_______________________________________________________________________
Home Phone _____________________________ Work
Phone________________________________
Employer ___________________________________________________________________________
Occupation__________________________________________________________________________
Spouse’s Employer __________________________________________________________________
Spouse’s Occupation
_________________________________________________________________
I hereby certify that I am a Democrat who supports
increased involvement and influence in the
Democratic Party and government affairs.
____________________________________________________ ___________________________
Your
signature Date
____________________________________________________ ___________________________
Spouse’s
signature Date
(State and Federal laws require us to use our best efforts to obtain mailing address, employer and occupation information of those who
make donations in excess of $50 per calendar year. Contributions may be used for political purposes.)