| Paulding
County Republican Party |
Print
this form and mail to...
P.O. Box 923, Dallas, Ga. 30132 |
Name
|
Phone
|
Address
|
Zip
Code
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E-mail
Address (optional)
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| Are
you a registered voter? Yes No |
| Would
you like to be added to our e-mail list? Yes
No |
| Would
you like to be added to the candidates e-mail lists? Yes
No |
|
| I
hereby make application for membership into the
Republican Party of Paulding County, and pledge myself
to the principles of the party and to do my utmost to
uphold such principles. |
|
Signature
|
Date
|
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| Additional
Information (optional) |
How
did you here about us?
|
What
is your profession?
|
What
are your hobbies or interests?
|
|
|
| I
have enclosed a check for...
(circle one) |
|
$20.00 for Full Membership
(membership dues for one
year)
|
$15.00 for Associate Membership
(non-voting membership dues
for one year) |
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