Membership Registration Form

Name

First NameLast Name

E-mail

example@example.com

Who referred you? (This is important for the contest, get your gf credit!)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Phone Number

Are you a US Citizen?

Are you a registered voter?

Are you a veteran?

Are you interested in any of the following?

Are you interested in sponsoring a meeting for a $100?

My Products

Regular Membership: Voting - $50/yr.

Regular Membership: Voting - $50/yr. WOMEN only. That is NOT a part of another Federated Club. Includes a $15 coupon for the Blue Jeans & BBQ Concert.

$50.00

Associate: Republican men - $35/y

Associate: Republican men - $35/yr-MEN only. Includes a $15 coupon for the Blue Jeans & BBQ Concert.

$35.00

Associate: Female member of another TFRW club - $35/yr

Associate: Female member of another TFRW club - $35/yr. We will call to verify what other TFRW club. Includes a $15 coupon for the Blue Jeans & BBQ Concert.

$35.00

Teen Republican Membership

Republican teens 13-17. Full year membership, and includes name tag. Includes a $15 coupon for the Blue Jeans & BBQ Concert.

$20.00 Quantity

Total

$0.00

Credit Card

Political Advertising Paid by RSRW PAC. Corporate contributions are not permitted. Contributions are not deductible as charitable Contributions for Federal Income Tax purposes

Red Stiletto Republican Women Membership Application

Credit Card