BAY COUNTY DEMOCRATIC PARTY

2009 MEMBERSHIP APPLICATION

(Please circle one): Miss/Ms./Mr./Mrs./Dr.
First Name: _________________________________ MI: _______ Last Name: ____________________________________
Home Address: ____________________________________________ City: _______________________ ZIP: ___________
Home Phone: (______)______________________________ Please Mail to my: (please circle one) Home / Office
Email Address: __________________________________________ Date of Birth: ___/___/______ Gender: ___________
mm/dd/ yyyy
Occupation: _______________________________________ Employer: __________________________________________
Work Address: _____________________________________________ City: ________________________ ZIP: _________
Work Phone: (______)_______________________________ Fax: (______)________________________________________
YOUR MEMBERSHIP IS VALID FOR ONE (1) YEAR FROM THE DATE WE DEPOSIT YOUR CHECK
All memberships are for an individual (except Couples memberships)

Please make checks payable to Bay County Democratic Party. Mail to: 2341 East Beaver Road, Kawkawlin, MI 48631.

Upper Clubs Sustaining Clubs Grassroots Memberships

 Trustee Club - $2,500*  Century Club - $125*  Couples - $60
($625 per quarter*) ($10 per month* ) Spouse:____________________________
 Supporter - $40
 President’s Club - $1,000  Neil Staebler Club - $78 *  Basic - $20
($250 per quarter*) ($6.50 per month* )  Student - $10
(*Upper and Sustaining Club memberships paid School: ____________________________
 Eleanor Roosevelt Club -$300 on a monthly or quarterly basis MUST be  Retiree - $10
($25 per month*) charged to a credit card)  Other $_________________________

 I am enclosing dues for a two (2) year membership

 Please accept my donation of $_________ to support Michigan Blue Tiger Democrats! www.michiganbluetigerdems.com

CREDIT CARD PAYMENT

Please charge my credit card: $___________ Full Amount  Quarterly (Upper Clubs only, Credit Card only)
Monthly (Upper/Sustaining Clubs only, Credit Card only)
#____________/____________/____________/____________ Exp. Date: _________________

Name as it appears on Card: __________________________________ Signature: ___________________________________________

Contributions are not tax deductible for federal income tax purposes.
Your contribution could be used in connection with federal elections and is subject to the limitations and prohibitions of the Federal Election Campaign Act. Paid for by
the Michigan Democratic State Central Committee/Michigan Democratic State Central Committee Federal Account, 606 Townsend, Lansing, MI 48933, 517-371-5410,
and not authorized by any federal candidate or candidate’s committee. Federal law requires us to use our best efforts to collect and report the name, mailing address,
occupation and employer of individuals whose contributions exceed $200 in a calendar year.

Membership Benefits
All Bay County Democratic members includes the MDP membership and a copy of the MDP newsletter and an official MDP
membership card.
Upper Clubs
Trustee Club: All of the benefits of the other clubs
plus a select Table of (10) tickets to Jeff-Jack, two
(2) tickets to the Fall Fundraiser & other events
throughout the year.
President’s Club: Receive a MDP lapel pin, plus
two (2) select tickets to Jeff-Jack, invitations to a
Private Reception before Jeff-Jack, two (2) tickets to
the Fall Fundraiser & invitations to other events
throughout the year.
Sustaining Clubs Grassroots Memberships
Eleanor Roosevelt Club: Receive a MDP lapel pin Couples Membership: Receive two (2) MDP
one (1) ticket to Jeff-Jack, an invitation to a Private lapel pins
Reception before Jeff-Jack & an invitation to other
special events throughout the year
Supporter Membership: Receive a MDP lapel
pin
Century Club: Receive a MDP lapel pin, an
invitation to a Private Reception before Jeff-Jack &
an invitation to other special events
Neil Staebler Club: Receive a MDP lapel pin & an
invitation to other special events