Membership Interest Form/Application

Are you interested in becoming a member? Join us in electing APA candidates and other Democrats into office. Use the form below to add your name to our list of supporters. You will have a chance to donate online once you press "submit".

District:	(16, 18, 20, or other)
First Name:
Last Name:
Address:
City:
State:
ZIP code:
E-mail:
Phone:	like this: (510) 555-1234 ()
Employer:
Occupation:
Comments, questions, feedback:
How did you find our organization?
Certifications:	I am a United States citizen or a permanent resident alien. I am making this contribution (and paying this credit charge) with my own personal funds, and I am not using funds provided by any another person or from any corporation, labor union or national bank to make this contribution. I am not a federal contractor. I am making this contribution on my own personal credit card and not with a corporate or business credit card or a credit card issued to anyone else.
Amount Due:

Contributions to the APADC account are subject to the prohibitions and limitations of the Federal Election Campaign Act. That law prohibits federal contributions from corporations, labor unions, and foreign nationals who are not admitted for permanent residence. All contributions must be made from personal funds and may not be reimbursed by any other person. Contributions are not tax deductible for federal income tax purposes.

Asian Pacific Democratic Caucus of Alameda County
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Paid for by the Asian Pacific American Democratic Caucus (www.APACaucus.org) and not authorized by any candidate or candidate's committee. Contributions to candidates or to the APA Democratic Caucus are not tax deductible.

Copyright 2005 - 2008 Asian Pacific Democratic Caucus
Please contact us: 510-522-7797 | Alameda, CA 94501
E-mail us at membership@apacaucus.org or by mail at:
APA Democratic Caucus, PO Box #20941, Castro Valley, CA 94546-8549
Tax ID# 202766727

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