Membership Application Form

APPLICANT INFORMATION

Name:  ___________________________________________________

Address:  _________________________________________________________

Phone  (home):  ___________________  Phone (work):  _____________ 

Phone (cell): _____________________

Email:  _______________________________________________________________________

(Important for many club communications, including meeting notices.)

What is your registered party affiliation? 

____________________________________________

I have enclosed payment for the following membership type:

___ General Membership (Republicans only)  

Annual individual membership fee of $25    

___ Charter (lifetime) Membership

One-time fee of $150

___ Associate Membership (for non-Republicans)

Annual individual membership fee of $25

Make checks payable to the Reagan Republican Club.  Completed membership application with payment should be mailed to: Treasurer, The Reagan Republican Club, P.O. Box 63, Phoenix, MD  21131-0063

Thank you for your support!

COMMIITTEES

The following committees have opportunities for involvement.  Members may join more than one committee, so please indicate your interests below:

___ Membership

___ Communications

___ Legal

___ Fundraising

___ Outreach

___ Precinct Organization

___ Legislative

___ Hospitality

___ Party Building