Accomack County Membership Form

Please click here to make your secure online payment before proceeding. You can also use this link to donate. Then, return back to this page to finish the process of membership.

Thank you.

There are two levels of Committee Membership: Voting Member and Supporting Member. Voting Membership is for those who can attend meetings and be involved quite regularly. Supporting Membership is for those who can only occasionally be involved in our activities, but wish to support the Committee.

Type of Membership

New Voting Membership, $15

Renewal of Voting Membership, $15

New Supporting Membership, $15

Renewal of Supporting Membership, $15

Name

First Name

Last Name

Email

Phone

(###)

###

####

Subject

Precinct Number (if known)

Home (911) Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Address

Is your Home (911) Address the same as your Postal Mail address?

Yes

No

Postal Mail Address

If you answered "no" to the above, please enter your postal mail address here.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date

MM

DD

YYYY

Signature

I hereby state that I am a Democrat, that I am a registered voter in the Precinct indicated.I believe in the principles of the Democratic Party and if applying for Committee Membership I do not intend, during my term as a committee member, to support any candidate who is opposed to a Democratic nominee.