NORTH SHORE REPUBLICAN WOMEN MEMBERSHIP 2025 FORM

NORTH SHORE REPUBLICAN WOMEN MEMBERSHIP FORM - 2025
Name*
Spouse Name if applicable
Home Address*
City*
Zip code*
Mailing Address If different for mailings
Home Phone

Area CodePhone Number
Cell
EMail
example@example.com
Texas Senate District in which you reside
Occupation Required for PAC reporting
OR (please check if retired)

Retired
NSRW may or may not publish this information in its printed and electronic form:*

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Do you want a Yearbook?*

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Prefer:*

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Please check one type of membership:

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Membership Fees: Check one*

Active membership is for all women with NSRW as their primary membership - $40Associate membership is for women with other Republican Women memberships, and men - $20Young Affiliate is teenage women ages thirteen through seventeen - $10Seniors 75+ discount offered: $30
Associate women please specify your other current active membership
Lighthouse Circle (see website): In addition, I would like to contribute $15, $25, $50 or any other amount to support various NSRW philanthropy programs (any amount would be greatly appreciated).

$15$25$50Other
NSRW has my permission to send the monthly Beacon newsletter to me by email:*

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SQUARE Credit Card Payment

USDMembership + Lighthouse (if chosen)

Political Advertising Paid for by North Shore Republican Women, Chris Gurley, treasurer, 49 Fairfield Dr., Montgomery, TX 77356. Contributions are not federal tax deductible as charitable contributions. Corporate Contributions Are Not Permitted.
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NORTH SHORE REPUBLICAN WOMEN MEMBERSHIP FORM - 2025