Membership Application Yes, I want to join the Alice B. Toklas Democratic Club! __$35 Regular __$100 Supporter __$250 Sponsor __$500 Champion __$20 Special Needs __Other __I am renewing my membership __I will be a new member
__I am a registered Democrat (required) Name ______________________________________________________________ Address _____________________________________________________________ City ____________________________________State: ______Zip: _____________ Phone: Day __________________________Eve: _____________________________ Email: _________________________________________ Please send checks payable to “Alice B. Toklas LGBT Democratic Club” and mail to: Alice B. Toklas LGBT Democratic Club 1800 Market Street, PMB#18 San Francisco, CA 94102