Name

First Name

Last Name

Type of Membership

Renewal

New Member

Affidavit of Eligibility

I request that the Democratic Party of Carroll County accept my application to serve as a voting member for the current year's membership term. I confirm that I am a current resident of Carroll County, Arkansas. As a voting member, I agree to abide by the rules of said committee and support the Principles of the Democratic Party. I am eligible and legally qualified to file for membership under the Rules of the Democratic Party of Arkansas.

I agree

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