SANDPIPER  REPUBLICAN WOMEN                                        

                                    2010 MEMBERSHIP APPLICATION/RENEWAL                                                    

New_____ Renewal_____                                                                          Voting Precinct________             

NAME: __________________________________________Spouse First Name:______________

ADDRESS: (mailing)_____________________________________________________________

CITY:_________________________________________________________ ZIP_____________

Telephone:____________________ Office____________________ Cell____________________                                                   

E-mail:____________________________________________________      

Birthday Month: ______________Day:________________

_________Renewal Member   $25         New Member    $25_________________                  

________  Associate Member $10           Home Club _______________________

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I would like to serve on the following committees:

TELEPHONE_____LEGISLATIVE_____FUND RAISING_____PUBLICITY_____MEMBERSHIP_____

CARING PROJECTS_____REGISTRATION_____BUDGET_____AUDIT_____BY-LAWS_____

DECORATIONS_____HOSPITALITY_____LITERACY_____CAMPAIGN_____

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Make Checks to:  SANDPIPER REPUBLICAN WOMEN PAC

Mail to:  Jane Murray, 914 Elm Pointe Dr., League City, Texas 77573

             Required PAC information:   Date of Contribution__________________________________________

 Purpose of contribution________________________________________

 Occupation:_________________________________________________

 Company___________________________________________________

 Position____________________________________________________

              Thank you for joining the Sandpiper Republican Women

                            We care…and we make a difference!