NEW MEMBERSHIP APPLICATION

NEW MEMBERSHIP APPLICATION

PAY ONLINE WITH CREDIT CARD OR PRINT & MAIL WITH PAYMENT TO: 1004 MAIN ST SANDPOINT, ID 83864
DATE*

MonthDay Year
YOUR DETAILS

NEW APPLICATION Pending Approval)RENEWAL
NAME*
COUNTY
ADDRESS*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
CELL PHONE
Please enter a valid phone number.
ALTERNATE PHONE
Please enter a valid phone number.
EMAIL*
example@example.com
PREFERRED CONTACT METHOD

Cell PhoneAlternate PhoneEmailText
VOLUNTEER INTERESTS How would like to participate?

Community ProjectsEventsFund-RaisingHospitalityMarketing & Graphics 5PublicityWebsiteOther
BIRTHDATE
MONTH DAY YEAR

MEMBERSHIP TYPE Select Membership Type

REGULAR MEMBERSHIPRegular Members may speak, vote, hold office, and serve on committees.

$30.00 Quantity

SUSTAINING MEMBERSHIPFeatures the same benefits as Regular Members. Payment includes a $5 donation toward the operational expenses of the group.

$35.00

ASSOCIATE MEMBERSHIP

$15.00

Total

$0.00

MEMBERSHIP REQUIREMENTS*

I am a registered Republican.I agree to abide by BCRW, Inc By-laws.
SIGNED

Clear
PRIVATE

THIS AREA FOR BCRW, Inc. BOARD & MEMBERSHIP COMMITTEE ONLY

____________________________________________________________

____________________________________________________________

____________________________________________________________

THIS FORM HAS BEEN REVIEWED: MEMBERSHIP IS APPROVED:

____________________________________________________________

Signed Date
Should be Empty:

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