NORTH SHORE REPUBLICAN WOMEN

P.O. Box 524

Willis, Texas  77378

 

MEMBERSHIP FORM

2009

PLEASE PRINT

Name:   _________________________________________________________________________

Spouse Name:        ________________________________________________________________

Home Address:      ________________________________________________________________

_____________________________________ Zip ____________ Precinct #:    _______________

Mailing Address:    ________________________________________________________________

_____________________________________ Zip ____________

 

Telephone #’s:

Home:  ____________________________      Work:    ____________________________________

Cell:      ____________________________      Fax:       ____________________________________

E-Mail:  __________________________________________________________________________

 

NSRW may/may not publish this information within its yearbook.  Please circle one and initial ________

 

Occupation (Required information for PAC reporting): __________________________________

 

Membership Fees:  (Please Circle)                     __________ New   __________ Renewal

Active:  $30.00         Associate:  $15.00              Young Affiliate:  $10.00

 

Active membership is for all women with NSRW as their primary membership.

Associate membership is for women with other Republican Women memberships and men. Associate Women please specify where your current active membership is ________________________________

Young Affiliate is teenage women ages thirteen through seventeen.

 

New Membership – Referred By: ____________________________________________________________

 

I’M INTERESTED IN SERVING ON THE FOLLOWING COMMITTEES (Please Circle)

Americanism           Campaign Activities          Caring for America             Hospitality   

Legislative                Membership                         Newsletter                            Publicity                   

Telephone                Ways and Means                Yearbook                              Women's Issues

 

Please mail this form with your check payable to NSRW at P.O. Box 524, Willis, Texas  77378.

 

NSRW MEETS THE 1ST WEDNESDAY AT THE BENTWATER COUNTRY CLUB

(unless otherwise specified)

PLEASE MAKE RESERVATION WITH CLUB FRIDAY BEFORE MEETING

Bentwater Country Club - 936/597-6219

 

Contributions are not deductible as charitable contributions for Federal Income Tax purposes. Political advertising paid for by NSRW PAC. Corporate contributions are not permitted.