(Please print this form, fill out, and send with check to address at the bottom)

Northern Orange Republican Women (NORW)

www.northernorangerepublicanwomen.org
larzkins@yahoo.com

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
in the Northern Orange Republican Women group.

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
______Bylaws                  ______Newsletter ______Fisher House
______Caring for America  ______Publicity        ______USO
______Hospitality ______Sunshine  
______Campaigns
______Legislative ______Telephone

Please check one or more of the areas that interest you:

______Assist with events, get out the vote efforts or other volunteer activities
______Serve as a club officer

Print this form and mail with check to:  Jan Wassel, Treasurer,
5204 Rileys Ridge Road, Hillsborough, NC  27278

PLEASE NOTE OUR PROUD SUPPORT OF OUR NORTH CAROLINA REPUBLICAN LOCAL AND STATE REPRESENTATIVES and VOTE FOR ALL OF THEM ON NOVEMBER 2nd, 2010!

To elect experienced, conservative judges in NC, just repeat this easy mnemonic:

Just Elect Strong Conservative People:

Jackson, Elmore, Steelman, Calabria, Poirier