Los Angeles Republican Clubs United
LAGOPCLUBS
Join Us
About Us
In Memoriam
Beach Cities Republicans
Board of Directors
Membership Application
Have You Heard Blog
Calendar
Contact Us
Torrance Lomita CRA
Peninsula Harbor Republicans
2020 Elections Rec's
Current Month Flyer
Support GOP Businesses
History of Betsy Ross and the American Flag
Clip Art
April 16 GotoMeeting
New Home Page
* For BCR Use Only *
Open to Republicans Only & Republicans guest(s) of members Only!
BEACH CITIES REPUBLICANS ONLINE MEMBERSHIP APPLICATION
*
Indicates required field
Date of Application MM/DD/YR
*
Check one:
*
Mr.
Ms.
Mrs.
Miss
Dr.
Hon.
Name
*
First
Last
Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Employer
*
Job Title
*
Cell Phone
*
Home Phone
*
Work Phone
*
Current /prior offices held (dates)
*
Email #1
*
Choose Any (Check One)
*
I am a registered Republican
I authorize the BCR to disclose my membership
Digitial Signature
*
Date MM/DD/YR
*
Spouse:
Check one
*
Mr.
Ms.
Ms.
Miss
Dr.
Hon.
Spouse Name
*
First
Last
[object Object]
Spouse Employer
*
Spouse Job Title
*
Email #2 (Spouse)
*
Spouse (Choose Any) (Couples Only)
*
I am a registered Republican
I authorize the BCR to disclose my membership
Digital Signature (Spouse)
*
Date MM/DD/YR
*
Membership: (Choose One)
*
NEW
RENEWAL
GIFT
Level of Membership: (Check) (Choose One)
*
Student $10.00 (Valid Current ID Required)
Regular Member $25.00
Couples Membership $40.00
Because I Can Member $50.00
Executive Member $100.00
Club Sponsor $500.00
Leadership Circle (Lifetime) $1000.00
How did you hear about us?
*
Friend
Email
Website
Newspaper
Interests: (check as many as you want)
*
Voter Registration
Online/digital/social media
Events/rallies/protests
Club leadership
Walk precients
Letters to the editor
Fundraising
Run for elective office
Phone calls/phone banks
School/youth programs
Technology/database
Other
If you'd check other; please write in reponse:
*
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
Beach Cities Republicans
Attn: Membership Dues
PO Box 1043
Palos Verdes Estates, CA 90274-7843
Submit Membership Application
