Stop The Corruption, Join the Club!!!

Republican Club of Luzerne County

2009 Membership Application

NAME: ________________________________________________________________________

ADDRESS: ______________________________________________________________________

CITY: ___________________________________________ STATE: _______ ZIP:______________

TELEPHONE: (HOME)_______________ (WORK) _________________(CELL)__________________

E-MAIL ADDRESS: ________________________________________________________________

VOTING PRECINCT:________________________________________________________________

Do you want your monthly newsletter sent to e-mail, mail or both? _________________________


OUR GOALS:
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.