GMWRC Membership Form

THE GREATER MCLEAN REPUBLICAN WOMEN'S CLUB

2012 MEMBERSHIP FORM FOR NEW MEMBERS AND RENEWALS

GMRWC Members are dedicated to:

Promoting an informed public through political education and activity;
Increasing the effectiveness of women in the cause of good government;
Electing Republican candidates; and
Promoting freedom, equality and justice - the principles upon which this country was founded.

Please make your check payable to GMRWC and mail it and this form to GMRWC, P.O. Box 417,
McLean, VA 22101-0417.

Regular Member: $40 dues_____ (includes one membership directory)

Asssociate Member: $25 dues____ (includes one membership directory) You must be a Regular Member
of another Federated Republican Women's Club to qualify for the Associate Member rate. Please state the club
where you hold Regular Membership: _____________________

I would also like to purchase a second copy of the membership for an additional $2, added to my check.
YES ______________________ NO _________________________

I would also like to make a donation to the club. Enclosed is my contribution:____________

Full Name (Nickname):___________________________________________________

Spouse Name:___________________________________________________________

Home Address:__________________________________________________________
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Precinct:_______________________________________________________________

Home Phone:____________________________________________________________

FAX:___________________________________________________________________

E-mail (please print):______________________________________________________

Employer:_______________________________________________________________

Work Phone:___________________________Cell Phone________________________
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Employer:________________________________________________________________

Occupation:______________________________________________________________
(Employer and Occupation will NOT be published in the membership directory, but are required
for federal reporting purposes. According to Section 6113 of the Internal Revenue Code, contributions to
GMRWC are not deductible for federal income tax purposes as charitable contributions. This provision
applies to organizations that are not eligible to receive deductible charitable contributions.)