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(Please print this form, fill out, and send with check to address at the bottom) Northern Orange Republican Women (NORW) 2010 Membership Application ANNUAL DUES: $35 (Payable to Northern Orange Republican Women) Additional Donation:______ Associate Dues: $25 The information below is needed for NORW use and to comply with federal regulations on political organizations NEW MEMBER: If you are a new member, previous member, or new associate member: Name__________________________ Precinct_____________________ Spouse's Name___________________________________ Occupation___________________ Employer_____________________ Address______________________ City______________ Zip_________ Home Phone_____________ Work______________ Fax_____________ Cell_________________ Email__________________________________ Referred by:_____________________________________________ By signing below, I certify that I am a registered
Republican and that I am applying for membership Signature______________________________ Date________________
EXISTING MEMBER: If you are a member and are renewing your membership: Name___________________________ Occupation_________________ Employer___________________ Spouse's Name__________________ Please provide your correct/newest information, especially any additions/changes to: Address__________________ City________________ Zip__________ Precinct__________ Home Phone_______ Work_________ Fax_______ Cell____________ Email_________________________________________
ADDITIONAL INFORMATION FOR CLUB USE ONLY Please check one or more of the following committees that interest you: ______Budget
______Membeship ______Ways & Means Please check one or more of the areas that interest you:
Print this form and mail with check to: Jan
Wassel, Treasurer, |
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