Los Angeles Republican Clubs United
LAGOPCLUBS
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* For BCR Use Only *
BEACH CITIES REPUBLICANS ONLINE MEMBERSHIP APPLICATION
Check one:
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Mr.
Ms.
Mrs.
Miss
Dr.
Hon.
Name
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Last
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Email #1
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Email #2 (Spouse)
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Employer
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Digitial Signature
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I am a registered Republican
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I am a registered Republican
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Student $10 (Valid Current ID Required)
Regular $25
Couple $40
"Because I Can" $50
Executive $100
Club Sponsor $500
Leadership Circle $1000
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Please make check to Beach Cities Republicans / Contributions NOT deductible for income tax purposes.
Please print this form with payment and mail to:
Peter Michel
C/O: Beach Cities Republicans
Attn.: Membership Dues
PO Box 1043
Palos Verdes Estates, CA 90274-7843
Submit Membership Application
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