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/yAssociate: 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/yrAssociate: 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 MembershipRepublican 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

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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

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