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First Name
Last Name
Email address
Phone
Address Line 1
Address Line 2
Town or City
State
ZIP
Committee Interests
Politics Activism
Communications Membership
Constitution Events
Fundraising
Membership Level
  • Basic Membership $15
  • Bronze Membership $25
  • Silver Membership $50
  • Gold Membership $75
  • Platinum Membership $100
  • Diamond Membership $250
  • Benefactor Membership $500

Email the Hell's Kitchen Democrats with any questions about your order.