Name *

First Name

Last Name

Phone number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am interested in:

Check all that apply.

Canvassing

Phonebanking

Textbanking

Voter registration

Tabling at events

Protesting/demonstrations

Community service

Fundraising

Data management

Social media

Digital/communications

Graphic design

Other

Democratic Party Registration Self-Attestation *

By checking this box, I attest that I am (or intend to become) a registered member of the Democratic Party and understand that I must be registered to vote as a Democrat in order to be a member in good standing of Antelope Valley Democrats for Change.

I am a registered Democrat