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“Where Democrats come together to help elect and reelect Democrats to Public office.”

Democratic Caribbean Caucus of Florida

Application for Membership

Please print and mail with check and copy of Voter Registration Card to:

Democratic Caribbean Caucus of Florida
PO BOX 641086
Miami, Florida 33164-1086

Telephone: (305) 655-1403
e-mail: tkpstate@yahoo.com
 

Annual Membership Dues

Regular
Students [18-25]
Civic
Small Business
Corporate

  $75.00
  $25.00
$100.00
$250.00
$750.00

Name:_____________________________

Address:___________________________

City:______________________________

State:_____________________________

Zip Code:__________________________

Home Phone:_______________________

Work Phone:_______________________

e-mail Address:_____________________

FAX Phone:________________________

Cellular Phone:_____________________

Precinct #:_________________________

Congressional District #:______________

Voter Registration #:_________________

Referred by:________________________

Political areas that interest you:

__________________________________

__________________________________

As a member of the Democratic Caribbean Caucus of Florida, I agree to support the organization’s goals, objectives, and mission.

Signature:__________________________

Date:______________________________