APPLICATION/RENEWAL

          (JULY 1 TO JUNE 30)

Dues: $ 15.00   One regular membership (one person), or
50.00                One membership & 1 meal ticket, or
100.00              One or two memberships & 2 meal tickets, or
175.00              Two memberships & 4 meal tickets
Please use the form below for your membership choice. Make check payable to and remit to:Republican Party of Door County, PO Box 94. Sturgeon Bay. WI 54235 Please be advised that we are not allowed by law to accept corporate check

NAME/S

ADDRESS

PHONE

E-MAIL

VOTING PRECINCT* _______________                  AMT. ENCLOSED________

*(where you vote, not mailing address; example: JC hall. Corpus Christi, City Hall, KC Hall, etc.) ACTIVITIES OF INTEREST/AREAS I (WE) CAN HELP WITH OR WISH TO BE CONSIDERED FOR:

___  DELEGATE/ALTERNATE ___EXEC. COMMITTEE

___ FALL DINNER              ___ LINCOLN DAY DINNER         ___ PARADES

___ COUNTY FAIR BOOTH      ___ MEMBERSHIP COMMITTEE   ___ COMMUNICATIONS  

___ CAMPAIGN HQ               ___ RESOLUTIONS COMMITTEE ___ POLL WATCHER

          ARE YOU CURRENTLY AN ELECTION WORKER?     Yes or No ___ IF NOT,  

         ARE YOU INTERESTED IN BEING AN ELECTION WORKER? ___ IF NEEDED

   ,     ARE YOU ABLE TO HELP FOLKS GET TO THE POLLS ON ELECTION DAY?

         AT CAMPAIGN TIME, ARE YOU ABLE OR WILLING TO DISPLAY CANDIDATE 

         SIGNS? COMMENTS? IDEAS? (use reverse, if desired)

Paid for by the Republican Party of Door County, Stephen P. Johnson, Treasurer