Please Print  this Application - fill it out - and Mail it to us,


Democrats of the Ozarks
P. O. Box 61 - Rolla, Missouri 65402 - 573-368-4477
Membership Application

Name ______________________________________________

Address _________________________________________________

Phone __________________

City ________________________  State _________  Zip _________

Occupation ________________________________         

Comments _____________________________________________   
                                                 (necessary for ethics commission reports)
 *Dues are $10.00 dues per year 

 Please enclose your checks payable to Democrats of the Ozarks and your comments:      

Democrats of the Ozarks
P. O. Box 61
Rolla, MO 65402

*FYI: Democrats of the Ozarks, is a Political Action Committee. Dues and/or contributions are not tax deductible.  
All contributions over $25 will be reported according to current Missouri Laws.