LOS ANGELES COUNTY DEMOCRATIC CENTRAL COMMITTEE

ALTERNATE MEMBER APPOINTMENT FORM: 2008-2010 TERM

Please print legibly in black ink and submit this form fifteen (15) days prior to the Los Angeles County Democratic Central Committee
meeting at which the appointment is to be announced. $36 Annual Membership Dues is required for Alternate Member appointed.

______________________________________
Date Submitted

Los Angeles County Democratic Central Committee

3550 Wilshire Boulevard, Suite 1203
Los Angeles, CA 90010
Fax: 213-382-1278

I HAVE APPOINTED THE FOLLOWING AS MY ALTERNATE MEMBER ON THE LOS ANGELES COUNTY DEMOCRATIC
CENTRAL COMMITTEE.

*Alternate Name: *Email:

*Phone (Cell): *Phone (Home): *Phone (Work):

*Fax: *Occupation: *Employer:

*Resident (Voting) Address:

*City: *ZIP:

Public Mailing Address (Skip if same as above):

City: ZIP:

*AD:_______ *SD:_______ *CD:_______ *Supervisorial District:_______________ *Bd. of Equalization District: ______________

*City Council of: *City Council District Number (If applicable): _____________
City Name

*Required information

PLEASE COMPLETE THE FOLLOWING AND PROVIDE THE PAYER INFORMATION OF MEMBERSHIP DUES BELOW:

Payment of $36.00 membership dues is paid in the form of (please check one):  Cash  Check  Credit Card

Name: Phone:

Card Type (Visa/MasterCard): Card Number: Exp. Date:

Address: City: ZIP:

Occupation (Required): Employer (Required):

APPOINTING MEMBER INFORMATION:

Signature of Appointing Member Print Full Name of Appointing Member Assembly District

**IMPORTANT** YOU MUST HAVE PAID YOUR DUES IN ORDER TO VOTE OR TO APPOINT AN ALTERNATE. THE
ALTERNATE WILL NOT BE SEATED IF YOU ARE NOT A MEMBER IN GOOD STANDING AND IF
HE/SHE HAS NOT PAID HIS/HER DUES.
Any member in good standing may appoint an alternate member, subject to the approval of This Committee, who shall serve at the member’s pleasure,
upon presentation of written authorization to the Chair of the Credentials Committee. Except at the Organizational Meeting, such appointment shall
not be submitted to This Committee for approval unless the Chair of the Credentials Committee has been notified of the appointment at least fifteen
(15) days prior to the meeting at which the appointment is to be announced.