Please print this form on your printer for membership applications. Mariposa Democratic Club Membership Form Dues are: $10.00 per year per person $15.00 per year for a family membership $150.00 for a lifetime membership The membership year runs from January 1st - December 31st. For more information see our web site at www.yosemitedems.net, or call 209-742-1010 for information. Today's Date: ________________ First Name: _______________________________ Last Name: _______________________________ Mailing Address: __________________________ City: ____________________________________ State: ______________________ Zip Code: __________________ Phone No. (please include area code): _________________________ e-mail address: ______________________________ First Name: _______________________________ Last Name: _______________________________ Mailing Address: __________________________ City: ____________________________________ State: ______________________ Zip Code: __________________ Phone No. (please include area code): _________________________ e-mail address: ______________________________ First Name: _______________________________ Last Name: _______________________________ Mailing Address: __________________________ City: ____________________________________ State: ______________________ Zip Code: __________________ Phone No. (please include area code): _________________________ e-mail address: ______________________________ Total Amount Enclosed: _____________________ Please mail form and check payable to the Mariposa Democratic Club to: Mariposa Democratic Club P.O. Box 5008-268 Mariposa, Ca. 95338 (209) 742-1010 THANK YOU!