Los Angeles Republican Clubs United
HOME PAGE
Join Us
About Us
In Memoriam
Beach Cities Republicans
Board of Directors
Have You Heard Blog
Calendar
Contact Us
September 14 Election
Current Month Flyer
Torrance Lomita CRA
Peninsula Harbor Republicans
Support GOP Businesses
History of Betsy Ross and the American Flag
Clip Art
April 16 GotoMeeting
* For PHR Use Only!
PENINSULA HARBOR REPUBLICANS ONLINE MEMBERSHIP APPLICATION
*
Indicates required field
Choose One
*
Mr.
Miss
Ms.
Mrs.
Dr.
Hon.
Name
*
First
Last
Spouse Name
*
Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mailing Address (If Different)
*
Line 1
Line 2
City
State
Zip Code
Country
Phone (Home)
*
Phone (Work)
*
Job Title
*
Employer
*
Membership (Select One)
*
New
Renewal
Honorary
Associate Member (Not a registered Republican)
Level (Select One)
*
Regular $25
Student $0
Family $39
Associate $39
Golden Elephant $69
Executive $99
Sponsor Member $249
Lifetime $999
Make Checks payable to: PENINSULA HARBOR REPUBLICANS
Interests (Check as many as you want)
*
Voter Registration
Get Out to Vote
School Programs
Phone Bank
Membership Building
Newsletter
Issues Research
Fundraising Events
Strategy & Planning
Writing Letters to Editor
Coalition Outreach
Other
Other Fill-In
*
I Certify that I am a Registered Republican:
Online Digital Signature
*
Date
*
I Certify that I am a Registered Republican:
Spouse Online Signature
*
Date
*
The Peninsula Harbor Republicans is a grass-roots organization. We encourage the participation of all Republicans in an honest and open forum, expressing divergent views in dialogue for the good of the Party and the Country. We unite following the Primary to support all Republican nominees in their election to office in the General Election.
We believe in the protection of individual and property rights, fiscal restraint, and smaller government. If you are interested in learning more, please complete this form and send it to the address shown above.
Extra Donations help fund the grass roots Get Out the Vote and Voter Registration Activities needed to elect Republican Candidates.
Before you click on Submit (Please Print this Online Application and mail with your check)
Return Application to: PHR, Attn. Peter Michel, PO Box 1043, Palos Verdes Estates, CA 90274-7843
Submit PHR Membership Application
