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Republican Club of the Plantation at Leesburg

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Application for Membership

Application for Membership

Republican Cub of the Plantation at Leesburg

 

Application for Membership

 

 

                                                                 Date ____________

 

 

Name ___________________________________________________

 

 

Address _________________________________________________

 

 

Phone Number ___________________________________________

 

 

Email address ____________________________________________

 

 

How long have you been a resident of the Plantation ___________

 

 

How many years have you been a registered Republican ________

 

 

Are you a member of any other Republican Club _______________

 

 

Have you ever been active in the Republican Party _____________

 

 

If the answer to the above question is yes, please explain ________

 

                                                                                            ____________________________________________________________

 

 

                                                                                                                      

Using your computer mouse, highlight only the application and print as a selection.
 
Mail with your $5.00 dues check to:
 
Republican Club of the Plantation at Leesburg
25428 Madewood
Leesburg, FL 34748

 
Paid Political Advertisement Paid for and Approved by Republican Club of the Plantation at Leesburg