Republican Club of Luzerne County
2009 Membership Application
CITY: ___________________________________________ STATE: _______ ZIP:______________
TELEPHONE: (HOME)_______________ (WORK) _________________(CELL)__________________
E-MAIL ADDRESS: ________________________________________________________________
Do you want your monthly newsletter sent to e-mail, mail or both? _________________________
To bring people into the Republican Party and to provide them an opportunity for political expression and recognition.
To train interested people as effective political workers and potential candidates and to help work toward the election of the Republican Party’s nominees on local, state and national levels.
To foster and encourage Republican Party activities including social events and to promote the party’s ideals and principles.
Signature:____________________________________________ Date: __________________
Enclosed is a check payable to Luzerne County Republican Committee for:
(please check appropriate lines)
______ YES, I WOULD LIKE TO JOIN THE REPUBLICAN CLUB. ENCLOSED IS $50 FOR MY ANNUAL MEMBERSHIP.