P.O. Box 1472, Dover, DE 19903-1472
Please Print!
Name:
___________________________________________
Address:
___________________________________________
City/State/Zip:
___________________________________________
Day and Night Phone(s):
___________________________________________
Email/FAX:
___________________________________________
To be a member of LPD, a person must be a resident of Delaware and either be a Voting Member of the National LP or a registered Libertarian voter or both.
The Libertarian Party is the Party of Principle. To assure and affirm that our party never strays from its principles, the National Libertarian Party requires that its members sign the pledge below.
I am a resident of Delaware and,
I hereby certify that I do not believe in or advocate the initiation of force as a means of achieving political or social goals.
Signature: _________________________________________
Or,
I hereby certify that I am a registered voter and have designated Libertarian as my party preference.
Signature: _________________________________________
Membership Level
[ ] $ 25 Basic
[ ] I wish to make an additional contribution for State activities.
Amount: $ ______________________________
Other membership levels:
[ ] $1000 Life
[ ] $ 500 Patron
[ ] $ 250 Sponsor
[ ] $ 100 Sustaining
Total Contribution (Membership plus one-time contribution):
Total Amount: $___________________________
Please make your check payable to "Libertarian Party of Delaware."
Your occupation*
_________________________________
The name of your employer*
_________________________________
*Government Mandated Notices: The Federal Election Commission requires political committees to report the name, mailing address, and occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. In accordance with the Internal Revenue Code, membership dues, contributions, and gifts are not deductible as charitable contributions for Federal Income Tax purposes. The Delaware state election code requires the same reporting information as the FEC and prohibits contributions in excess of $50 by cash and requires reporting if contributions are in excess of $100 during an election period.