____ Yes, I would like to become a Sustaining Member today! Please select an option:

                  ____ MONTHLY BANK DRAFT AUTHORIZATION
I give the Brazos County Democratic Party authorization to debit my account on or about the 10th of each month.

Bank: _________________________________ Acct. Number: _______________________________

Please enclose a voided check; the numbers at the bottom are necessary for correct routing.

_____ $15 _____$25 _____$50 _____$75 _____$ 100 _______Other

 
 
                  ____ CREDIT CARD   Card type: _____ Mastercard   ______ Visa

Quarterly $ ______	Semi-Annually $ ________	Annually $ _________
($30 or more)	($60 or more)	($120 or more)

Name as it appears on card: _______________________________________

Card Number:______________________________ Expiration Date:______________

Signature: _____________________________________________

 
                  ____ DIRECT BILL:

Quarterly $ ______	Semi-Annually $ ________	Annually $ _________
($30 or more)	($60 or more)	($120 or more)

_____________________________________________________________________________________

 
_____ No, I do not wish to become a sustaining member at this time. But will make a contribution to the party.

____$25   _____$50   _____$100   _____$200   _____$500   _____Other $__________

 
_____ VOLUNTEER:

_____ Yard Sign                                  _____ Assist your precinct chair by block walking

_____ Be a precinct chair

_____ Work at special events             _____ Assist at the party headquarters

 
Please complete:

Name: _______________________________ Address __________________________________________

City: ___________________________________ State: ___________________ Zip: ______________

Home phone: ________________________________ Office phone: ________________________________

Email: _____________________________________ Occupation: __________________________________

(Necessary for Texas Ethics Reports)

 
My precinct number is _________________

Please return to the Brazos County Democratic Party, P.O. Box 4568, Bryan, Texas 77805
Come visit us at 307 S. Main St. #102, Bryan, Texas 77803
Email us at brazosdems@verizon.net
Phone: 979.779.5600     Fax: 979.779.5601                         (August, 2005)