Application for Membership to the
            Eleanor & Franklin Roosevelt Democratic Club



 

Name:    _________________________________________________________




Address: _________________________________________________________
                          Number and Street




         _________________________________________________________
                    City, State, and Zip




Phone:   _______________________________________________ (Home)




         _______________________________________________ (Work)




E-mail:  _________________________________________________________



Please sign me up for periodic e-mail messages that are forwarded by 
our Club President (your e-mail address will never be shared with
any outside source): ____ Yes



Please find enclosed my check / cash (circle one) for 


         $ ______________


Dues are $5.00/year (October through September). Dues for seniors is $3.00/year.

Additional donations are most welcome to support the Club's activities. Because 
the Roosevelt Democratic Club is a political organization, dues and donations
are not tax-deductible.



Bring to the next meeting, or send to:

Eleanor & Franklin Roosevelt Democratic Club
P.O. Box 824
Greenbelt, MD 20768