Schaumburg Area Democratic Organization
PO Box 957752 Hoffman Estates, IL 60195-7752 847.843.0744
Membership Enrollment Form
Please print
Last Name: ___________________________ First Name: ___________________________
Address: _____________________________ Precinct No. ___________
City: _____________________ State: __________ Zip Code: ______________
Home Phone: ______________ Work Phone: ______________ Cell Phone: ______________
E-mail Address: __________________________________________________
Occupation :______________________________________________________
Date of Birth: ___________/___________/_____________
Would you like to be an election judge? Y N
Would you like to be a precinct captain? Y N
Are you, or would you be, free on Election Day? Y N
Please check one: New Membership 
Renewal 
Annual Dues: $15.00 per member
Please mail your check to the address above, Attention Membership