Become Member

AAC-NCDP Online Membership Application

Name*

County*

Birth Date*

Address*

City/Town*

State*

Zip Code*

Phone – Mobile/Home*

E-mail*

Registered Democrat*

Occupation

Employer

State law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for everyone whose contributions exceed $50.00 in an election cycle (2 years)

Membership*

African American Member - $5 yearly
Non-African American (Associate Member) - $5 yearly

Additional Donation $

Are you a member of the State Executive Committee (SEC)?*

County Precinct

US Congressional District*

Verified voter registration in State BOE computerized listing?*

Date Joined dd/mm/yy*