Member Contact Information

The first set of questions are requested so that we have basic contact information and can reach you in accordance with the specifications you provide to us. BCDA will not share your personal information except as authorized by you and will only provide necessary contact information to other members of BCDA who are working in the volunteer functions in which you've indicated an interest in participating. You may notify BCDA at anytime that you want your information removed from our database and we will honor your request to do so.

* 1. Please indicate your name below.

* 2. Where are you currently employed? Note: We will not contact your employer. We are asking this question so we can build a local network and, when important things need done that affect various businesses and where your Democratic friends have an interest, we know we can contact you to share that information or to request your assistance. We realize that issues affecting your employer may be sensitive. We promise to be discreet in contacting you and to be understanding in your willingness or unwillingness to assist us. If you do not feel comfortable providing this information, we understand if you leave it blank.

* 3. Please let us know what phone number to use to reach you.

* 4. At what email address would you like to be contacted?

* 5. Please provide us with a mailing address, including street number, street name, city, and zip code.

* 6. If you do NOT want your email address shared with other WV Democratic Organizations, please check the box below. If you do not opt out by checking the box below, we will occasionally provide email addresses to the West Virginia Democratic Party, the Young Democrats of the Eastern Panhandle, and/or the Berkeley County Democratic Women's Club. We promise not to abuse the use of your email address and to only contact you or share your email with these other organizations when we believe the information to be communicated to you is consistent with your demonstrated interest in Democratic principles and goals. All email sent from the BCDA will give you an option to unsubscribe.