EmailMe Form - C-PAC Membership

Name

First Last

Employer Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Message

Country of Origin

Required by the DC Board of Elections

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Employer

Required by the DC Board of Elections

Please indicate the C-PAC Committee(s) on which you are prepared to serve:

Advisory Committee

Fundraising Committee

Membership Committee

Political Outreach Committee

Membership Pledge

Associate (Student): $25.00

Special (Senior Citizen, 65+): $25.00

General: $50.00

Life: $5,000.00

Note: after you fill out this application, you can directly pay your membership dues online securely via our PayPal account. Please click on Submit to continue