LGBT Caucus of the Democratic Party of Virginia
Membership Form 

Completing this form and paying the applicable dues will entitle the those listed on the membership form to all rights and privileges of membership to the Lesbian, Gay, Bisexual, Transgender and Family and Friends Stonewall Caucus of the Democratic Party of Virginia, the official LGBT constituency group of the Democratic Party of Virginia. Membership to the LGBT Caucus, including the payment of yearly dues, supports the efforts of the LGBT Caucus. A form may also be downloaded, completed, and mailed or submitted in person.

Is this a renewal or a new membership?
 Is this a single or couple membership?
Please complete your information and your partner's information as applicable.
Your First Name:
 Your Last Name:
Your Partner's First Name:
 Your Partner's Last Name:
Your Phone Number:

Your Partner's Phone Number:
Your Email Address:
 Your Partner's Email Address
Relationship Legal Status:
  
Street Address:
City:
State:
 Zip Code:
Submitting this form is agreeing that the persons listed above are Democrats, are registered voters in the city or county listed above, believe in the principles of the Democratic Party, and do not intend to support any candidate who is opposed to a Democratic nominee in the next ensuing election.

A link will be sent via email that may be used to pay the dues applicable with this membership.
 

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