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2014 Suffolk Democratic Committee Chairman's Club Directory

2014 Chairman's Club Directory

2014 Chairman's Club Directory

Thank you for joining the Chairman's Club this year!

Please fill out the form below to be included in this year's directory.

Please do not include the address, email, phone or fax number of any government office

* Required

Membership Type *

Executive Member $250
Pearl Member $500
Sapphire Member $1,000
Ruby Member $2,500
Emerald Member $5,000
Diamond Member $10,000

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Payment Method *

I paid via credit card online
I paid via check

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I am eligible to make a contribution to the Suffolk County Democratic Committee *

You hereby affirm that, to the best of your knowledge, neither you nor any entity which you own or currently control: a) is an employee of the Town of Babylon or b) is currently doing business with, has a contract with or an application before the Town of Babylon or has done business with, had a contract with or an application before the Town of Babylon within the past two years.

Yes
No

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Your first name *

For contact purposes

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Your last name *

For contact purposes

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Your phone number *

For contact purposes

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Your email *

For contact purposes

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Business Name/Individual Name *

This is how your listing will appear in this year's directory

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Contact name for above *

To appear in this year's directory

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Address *

To appear in this year's directory

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City *

To appear in this year's directory

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State *

To appear in this year's directory

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Zip *

To appear in this year's directory

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Phone *

To appear in this year's directory

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Email *

To appear in this year's directory

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Fax *

To appear in this year's directory

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Classification *

To appear in this year's directory (if "other", see below)

None/Individual
Accountants
Architects
Artists
Attorneys
Auctioneer
Auto Sales
Business Development
Consulting Engineers
Contractor & Supplier
Energy Services
Financial Services
Garden Center/ Nursery
Health- Athletic Club
Health Services
Insurance
Manufacturer
Photographer/ Audio-Visual
Printing
Public Relations
Real Estate
Restaurants & Catering
Sports Complex
Technical Institute
Telecommunications
Title Insurance Services
Transitional Services
Transportation Services
Waste Management
Other:

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Suffolk County Democratic Committee
1461 Lakeland Avenue, Suite #3
Bohemia, NY 11716
Tel: (631) 439-0400 - Fax: (631) 439-0404
Email: info@suffolkdems.com

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