Standard Membership (Household) Application

Thank you for supporting the Florida LGBTQ+ Democratic Caucus. To complete your new membership or renewal application, please answer the following questions and click the SUBMIT button.

After you submit your application, you will be re-directed to the PayPal website to process your household membership dues payment of $50.

* indicates required field

First Name:*

Last Name:*

2nd Member's Name:*

Email:*

Re-enter Email:*

2nd Member's Email:

Date of Birth:*

Street Address:*

(Include apartment or suite number if necessary.)

City:*

State:*

(Use two-letter abbreviation.)

Zip Code:*

Telephone Number:*

County of Voter Registration:*

Are you a local DEC member or elected official?*

Yes
No

If you answered yes to the previous question, please provide title of office held:

Gender:

(For statistical reporting purposes.)

2nd Member's Gender:

(For statistical reporting purposes.)

Race:

(For statistical reporting purposes.)

2nd Member's Race:

(For statistical reporting purposes.)

Membership Status:*

New Member
Renewal

Membership Type:*

Voting Member
Associate Member