Los Angeles Republican Clubs United
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LAGOPCLUBS - Credit Card Authorization
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Indicates required field
Name
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First
Last
Cardholder Billing Address
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Line 1
Line 2
City
State
Zip Code
Country
Card Holder's Phone Number
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Cardholder's Email
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Membership Levels (Choose One)
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Student $11.00 (Current School Year)
Individual Membership $26.00
Couples (2 people same address) $42.00
Because I Can $52.00
Executive $54.00
Club Sponsor $520.00
Lifetime Leadership Circle $1,040.00
* Credit Card membership includes a 4% credit card processing fee.
Type of credit card (Select One)
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Visa
Mastercard
Discover Card
American Express
Credit Card #
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Credit Card Zip Code
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Credit Card Expiration Date (MM/DD/YR)
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Security Code (3-digit code on back of card)
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Security Code (4-digit for American Express Cards)
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I authorize
LAGOPCLUBS/Beach Cities Republicans
to charge the membership dues to my credit/debit card provided herein. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.
Cardholder Digital Signature
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* Once you hit submit, your credit card authorization will be received and we will process your credit within 24-72 hours after receipt. You will receive a email once we process your credit card.
Submit for processing
