EmailMe Form - C-PAC Membership

Name *

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Email *

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Address

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

If you live in the District of Columbia, please indicate which ward you live in:

You can find a list of DC wards here (link opens in a new window).

If you live in Maryland, please indicate which congressional district you live in:

You can find a list of MD congressional districts here (link opens in a new window).

If you live in Virginia, please indicate which congressional district you live in:

You can find a list of VA congressional districts here (link opens in a new window).

Country of Origin

For internal use only

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

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