Mail-In Membership Form

Mail-In Membership Registration and Contribution Form

Any personal information that you give us will be used only for the purposes of processing membership contributions and better serving our members. This information will not be sold, rented, or shared with any party not directly affiliated with ReformDemocrats. If you have any questions or concerns, please contact us at info@reformdemocrats.org.

You can print out the following form and fill in the information

OR

You can fill in the information and print out the form

About You

First Name:

Last Name:

Address:

City:

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ZIP:

Phone with area code:

Best time for us to call you:

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Email:

Area of Greatest Concern:

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How did you learn about us?

If you chose "member," please enter referring member's name:

Membership Dues

You have two payment choices:
1. Pay monthly If you would like to write a check each month to pay your membership dues, please mark the above circle.
Dues Amount: $
The Dues Amount depends on your generosity, but the minimum is $10.00.
OR
2. Pay annually or semi-annually.
Dues Amount: $
If you would like to pay for a six month (minimum $60) or a yearly membership (minimum $120), mark the correct circle below.
Six month membership	One year membership
Membership dues, contributions, donations, or gifts to ReformDemocrats are not deductible as charitable contributions for federal income tax purposes. ReformDemocrats does not accept contributions from corporations or interest groups. We only accept contributions from individuals.

Donation

If you would like to make a donation to ReformDemocrats, separate from your membership dues, please fill in the amount below.
Donation Amount: $
Would you like to restrict the use of your donation?	Yes No
If yes, select area of use:

Please print and mail this form along with your payment to:

ReformDemocrats
P.O.Box 52886
Bellevue, WA 98015-2886