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First Name
Last Name
Email address
Phone
Address
Political Interests
Poverty and jobs Affordable housing
LGBTQ rights Racial justice
Women's right to choose Affordable healthcare
Preserving the character of our neighborhood Climate change
Public education
Membership Level
  • Basic Membership $10
  • Bronze Membership $25
  • Silver Membership $50
  • Gold Membership $75
  • Platinum Membership $100
  • Diamond Membership $250
  • Benefactor Membership $500

Email the Hell's Kitchen Democrats with any questions about your order.