Anyone between the ages of 18 and 40, a Tippecanoe County resident, and a registered voter is eligible to be a Tippecanoe County Young Republican.
To join please print this form, fill out and mail with payment to:
Tippecanoe Young Republicans Club, 839 Main Street, Lafayette, IN 47901
Tippecanoe Young Republicans
Membership Application
| Are you applying for: ___ Single member ($15) ___Couple ($25) ___Associate ($10) | |
| Your name: ________________________ | Your birthdate: ________________________ |
| Spouse name: ________________________ | Spouse birthdate: ________________________ |
| Home address: ______________________________________________________________ | |
| Home phone:________________________ | |
| Your work phone: ________________________ | Your email: ________________________ |
| Spouse work phone: ________________________ | Spouse email: ________________________ |
|
What are your areas of interest? __________ Issues and Platform __________ Fundraising __________ Publicity __________ Club Newsletter __________ Social Events __________ Phone Calling __________ Campaigns __________ Recruiting Members __________ Speakers for Meetings __________ Voter Registration __________ Holding Club Office (specify 2): ______________________________________ |
What are your spouse’s areas of interest? __________ Issues and Platform __________ Fundraising __________ Publicity __________ Club Newsletter __________ Social Events __________ Phone Calling __________ Campaigns __________ Recruiting Members __________ Speakers for Meetings __________ Voter Registration __________ Holding Club Office (specify 2): ______________________________________ |
|
Your signature:
_____________________________ |
Date:
______________ |
|
Spouse signature:
_____________________________ |
Date:
______________ |
