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THE LEELANAU COUNTY DEMOCRATIC PARTY
2010 MEMBERSHIP FORM
Name(s)__________________________________________________
Address (If applicable, include both street address and P.O. Box)
_____________________________________________________
_____________________________________________________
City_____________________________ State_____Zip________
Telephone__________Email_____________________________
(LCDP does not release email addresses of its members)
* Occupation_________________Employer Name_________________
* Employer Address__________________________________________
(*required by law)
Dues ($10/person/calendaryear)____________Donation___________
(Dues and donations are not U.S. tax deductible)
Please make checks payable to: Leelanau County Democratic Party
and mail to: Leelanau County Democratic Party
c/o Charles Godbout, Treasurer
P.O. Box 215, Empire, MI 49630
Check here if you wish to be added to our list
of volunteers
