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Membership Registration/Renewal Application
New member applications will be effective upon application submission, payment of dues and approval of the Executive Board.
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Email
*
Your email
Name
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Your answer
Your Birthdate (month, day)
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Your answer
Local Address (Zip + 4)
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Spouse's Name
*
Your answer
Voting Precinct #
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Your answer
Summer/Alternate Address (Zip + 4)
Your answer
Local Address, phone and fax numbers, and email addresses are included in the Membership Directory. If you prefer not to have this information listed, please list information you would prefer listed in the alternate address area. Thank You.
Your Registered District #
*
Your answer
Check Appropriate Box
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Today you are a New Member
Today you are Renewing your Membership from last year
Membership Types (must be registered Republican)
Choose
$100 Founding Member
$50 Patron
$30 Full
Founding, Patron and Full members have full voting privileges. Founding and Patron are full members who wish to further their financial support of the Club and will receive special recognition on the website.
Are you a member of another political organization?
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Yes
No
If so, please list:
Your answer
How did you hear about LCRP?
Your answer
By Signing this Application, I certify I am a registered Republican and will adhere to the policies of LCRP by supporting Republican candidates in primary, general or special elections. I will not engage in activities or derogatory conduct that is deemed unacceptable by the LCRP Executive Committee to injure the name of, or interfere with the activities of LCRP, or the Republican Party.
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Your answer
Today's Date
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MM
/
DD
/
YYYY
I'd like to get involved! I'm interested in the following areas: (check all that apply)
Campaign Volunteer
Fundraising
Hospitality
Legislation
Mailings
Membership
Phoning
Reservations
Publicity
Technology
Submit this application online and make your dues check payable to LCRP and mail it to P.O. Box 100581, Cape Coral, FL. 33910
A copy of your responses will be emailed to the address you provided.
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