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Declaration of Candidacy for Membership to the Chesterfield County Democratic Committee

By completing this form, I hereby declare myself to be a candidate for membership on the Chesterfield County Democratic Committee. I also declare that I believe in the principles of the Democratic Party and that I will not support any candidate opposed to any candidate nominated or supported by the Democratic Party as long as I am a member of the Committee.

Dues are $30 for one year or $50 for two years. You will be prompted for a payment option at the end of the form. Dues can be waived for financial hardship.

First Name

Last Name



Zip Code

Email Address

Phone Number

I am a Registered Voter in Chesterfield County and reside in the following Magisterial District:

The following information is required by the Campaign Financial Report provisions of Virginia Law as any payments
made by you to CCDC, including dues, are reported to the State Board of Elections.

If employed please list employer and occupation:


I wish to pay for my membership the following way: