Democratic Central Committee Registration

Name *
Prefix
First *
Last *
Suffix
Email *
Home Phone Number *

###
-
###
-
####
Cell Phone Number

###
-
###
-
####
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
District
Affiliation *
 Central Committee Member 
 Candidate/Legislator 
 ADP Staff 
 Interested Democrat 
 Other 
Registration includes admission to Rock the Homer Vote, the Central Committee Meeting (including breakfast, lunch with Just a Girl from Homer and some of our Candidates, and snacks). *
 Early Registration $75 by September 6 
 General Registration $85 by October 9 
Make checks payable to: District 35 Democrats. Mail checks to: D35/Liz Downing, 1247 Bay Avenue; Homer, AK 99603. For credit card payment, call ADP at 258-3050.
Saturday Lunch Choice
 Halibut Illiamna 
 Meditteranean Pasta (vegetarian) 
 Sirloin Skewers 
 Rosemary Chicken 
Comments or Accommodations Requested
Powered byEMF Online Survey
Report Abuse