Fulton County Democratic Party
Join, Help Out and Stay In Touch

Please provide the following information:
 * = required fields

I want to (check all that apply): Volunteer  Join Contribute Receive Mailings and Emails
Contact Information:
* First Name
* Last Name
Street Address
Address (cont.)
City
State/Province
*Zip/Postal Code
Country
Work Phone
Home Phone
FAX
* E-mail
Age

 

Volunteering:
I would like to volunteer to help (check all that apply):
Work at the polls Help with phone banks Post a yard sign	Walk my neighborhood Write letters Other - I'll help anyway I can
Joining: Membership supports the Party and local candidates.
General membership $10	Century Club $100 - Join at this level and receive 2 tickets to the annual Jefferson/Jackson dinner!
Donate/Contribute:
I would like to contribute $ to the Fulton County Democratic Party. To contribute, please print this form and mail to the addresses shown below.
Other:
I am registered to vote in the next election or primary:    Yes No
I plan on voting Democratic in the next election:    Yes No Undecided
I need help getting to a the polls on election day:    Yes No
Please share your thoughts on how the Fulton County Democratic Party can improve our community and our country:

 

Donations and Contributions, please make your checks out to Fulton County Democratic Party and mail to:
General Membership ($10.00 or more): Lois Ulerick, FCDP Treasurer 713 Fulton Ave Rochester, IN 46975	Century Club ($100.00 or more) Karen Miller, Century Club Chairperson 202 Fulton Ave Rochester, IN 46975

Revised: 06/11/08