Questionnaire - SHDEMS

Southampton Town Democratic Committee.

2022 Membership Information.

Thank you for taking a few moments to submit your Southampton Town Democratic Committee Membership application or to update your existing membership details. The goals of this questionnaire are:

Facilitate communication between Committee members and Democratic elected officials
Prioritize issues and agendas on which to focus
Learn of the talents, interests and expertise of Committee members
Share these talents, interests and expertise with Committee members and Democratic elected officials

Name
First Last
Election District:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address:(if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address:
Phone
Cell Number:
Professional background: (Attach a separate sheet if necessary)
Other Affiliations/Organizations/Memberships:
Issues of importance to you:
Would you be interested in joining these sub-committees or assisting in:
- Fund Raising / Events
- Outreach / Member Recruitment
- Get Out The Vote (GOTV)
- Youth Engagement
- Campaign Support
The minimum support we request of you:*
- Petition/ Signature Gathering (Note that carrying petitions is mandatory)
Other concerns or suggestions:

PLEASE NOTE:

Communication will primarily be through email.

If you would like to email this form click here to download a paper copy.

Please be considerate of members and pass all pertinent and relevant email messages through Gordon Herr, Chair, Southampton Town Democratic Committee (gordon@shdems.org). P.O. Box 472, Southampton, NY 11969

Southampton Town Democratic Committee.

2022 Membership Information.

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