Membership Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
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.
*
Membership Level
*
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( X )
New Regular Membership
$
50.00
New Associate Membership
$
50.00
Regular / 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
Pay
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
Checkout
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