REPUBLICAN PARTY OF CLARK COUNTY

MEMBERSHIP APPLICATION

 

 

_____Membership Renewal            ______New Member               ______Change of Address

Suggested Annual Membership Dues; January 1 through December 31

_____$15 Individual         _____$25 Couple             _____$25 Associate Member (non resident)

 

Name________________________________________________________________

Address_______________________________________________________________

City _________________________________State__________ Zip Code___________

Home Phone ______________Work Phone ______________

Email_________________________________________________________________

 

I affirm that I am eligible to vote in any national or state election, and believe in the objectives, purposes and principles of the Republican Party; and will preserve our Republican form of government as created under the Constitution of the United States and the Constitution of Wisconsin.

 

Signed_______________________________________________        Date______________

Make checks payable to:

Republican Party Clark County

Send to; P.O. Box 183, Neillsville, Wi. 54456

Count on me to help with:

_____membership                        _____phone calls                ____ yard signs

_____mailings                _____fair booth                      ____fund raiser

_____special events                                     _____other ______________

Optional: State law requires that we ask your occupation and employer’s name and address, if your contributions total $100 or more in a year.

Occupation_________________Employer_______________________________

Employer’s Address__________________________________________________

Authorized and paid for by Republican Party Clark County, Sandy Luedke, Treasurer

 

Please contact Charlotte Rasmussen with any questions or concerns. Email charlotteras919@gmail.com