Membership Application
Your Brevard Federated Republican Women Club due in includes the Membership in the National Federation of Republican Women (NFRW) and Florida Federation of Republican Women (FFRW). Membership is from the date of joining through December 31. All memberships renew on January 1st, regardless of the calendar date you joined. If you joined after October 1, your membership will include the remainder of the current year of BFRW membership at no cost and a full membership for the following calendar year.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone Number
*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Birthday
*
-
Month
-
Day
Year
Date
Voter Registration Number
If not Retired, Please fill out Employer and Occupation.
Retired
Employer
Occupation
Please tell us how you would like to volunteer
*
Greeter at meeting
Lead Pledge
Sing Anthem
Lead Invocation
Fundraising
Special Event
Computer Work
Mailings
Telephone Calling
Walk Neighborhoods
Other
Military Service
Self
Spouse
Active
Retired
Veteran
Other
Branch and Rank
Branch
Rank
Membership Level
*
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( X )
New Regular Membership
$
50.00
New Associate Membership
$
50.00
Membership Renewal
$
45.00
Associate Membership Renewal
$
45.00
Stilettos Membership
Includes Regular or Associate Membership
$
150.00
Peal Membership
Includes Regular or Associate Membership
$
250.00
Diamond Membership
Includes Regular or Associate Membership
$
500.00
MAGA Membership
Includes Regular or Associate Membership
$
1,000.00
By signing this application I certify that I am a Registered Republican. I give my permission to be listed in the membership roster and receive notification emails and communications from the organization. Disclaimer of Liability: Your participation and attendance of activities of the Club is at your sole risk and neither the Club nor any member will be responsible.
*
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