Federated Republican Women of Panama City Beach
P. O. Box 18341, Panama City Beach, Florida 32417
LAST NAME __________________________ FIRST NAME ______________________________ ZIP + 4 _________________________ HOME PHONE ____________________________________ WORK PHONE _____________________ CELL PHONE _________________________________ EMAIL ___________________________________________ BIRTHDAY _____________________ (MONTH & DAY) OCCUPATION/FORMER, IF RETIRED ________________ SPOUSES NAME ______________ HOBBIES __________________________________________________________________________ DUES PER YEAR: January 1st to December 31st: _____ $35.00 Membership _____ $20 after July 1st _____ $15.00 Associate Membership I AM INTERESTED IN SERVING ON THE FOLLOWING CLUB COMMITTEES: CARING FOR PUBLICITY ____ TELEPHONE ____ MEMBERSHIP ____ FUNDRAISING ____ NEWSLETTER ____ BY-LAWS ____ PROGRAMS ____ BUDGET ____ WOULD YOU CONSIDER A LEADERSHIP ROLE IN OUR CLUB? ____ WOULD YOU CONSIDER RUNNING FOR PUBLIC OFFICE? ____ I swear I will not actively, publicly or financially support the election of any candidate other than Republican candidates in an election. Further I swear I will not engage in activities or conduct that may injure the name of the Republican Party or the Federated Republican Women. SIGNATURE _______________________________________________DATE _____________ Make Checks payable to: FRW of PCB Respond to: FRW of PCB Panama City Beach, FL 32417 eff 11/01/08
Federated Republican Women
of
www.frwpcb.com
