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BROWARD WOMEN’S REPUBLICAN CLUB, FEDERATED MEMBERSHIP APPLICATION Please print this form, complete it and send it in with your check to the address provided below. Name __________________________________________________ Address ________________________________________________ _________________________________________________ Telephone/Fax ___________________________________________ e-Mail __________________________________________________ Are you a member of any other Republican club? If so, which one (s)? ________________________________________________________ ________________________________________________________ Precinct Number ________ Date ________________ I am interested in helping on the following committees: (Please check all that apply): ___Campaign/Legislative ___Phone Tree ___Fundraising ___Special Projects ___Newsletter ___Other_______________ Dues: MEMBER: $25.00 ASSOCIATE MEMBER: $15.00 Please make check payable to Broward Women’s Republican Club, Federated and mail to: Antonia Hyland 427 Deer Creek Run Deerfield Beach, FL 33442 |
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