GMWRC Membership Form

THE GREATER MCLEAN REPUBLICAN WOMEN'S CLUB

MEMBERSHIP FORM FOR 2010 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, along with this form to GMRWC, P.O. Box 417, McLean, VA 22101-0417.

Regular Member: $40 dues_____. Asssociate Member: $25 dues____.

You must be a regular member of another Federated Republican Women's Club to qualify for this rate.

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

Full Name (Nickname):__________________________________________________

Spouse Name:___________________________________________________________

Home Address:__________________________________________________________

Precinct:______________________________________________________________

Home Phone:____________________________________________________________

FAX:___________________________________________________________________

E-mail:________________________________________________________________

Employer:______________________________________________________________

Work Phone:____________________________________________________________

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.