Please provide the following information: Name: _____________________________________ Spouse: ________________________________ Street Address: _____________________________ County of Residence: Home Phone: __________________ Office Phone: __________________ Cell: __________________ Office Fax: __________________ E-mail Address: ______________________________________________________________________ Preferred Method of Communication: Email Snail Mail Home Phone Office Phone 2010 Dues: Now Due __$30 Full __$15 Associate Member since: _________________________ For Female Associate Members only, Primary Club: __________________________________________ Name Tag I would like to have a personalized HPRW name tag for $12.50? Yes ____ No ____ Computer Skills Are you proficient in any of the following? MS Word ___ MS Excel __ Desktop Publishing __ Websites __ Other __________________________ Areas of Involvement Interested? Board Position Campaigns/Issue Research Community Service Programs Publicity Social Ways & Means Please make your check payable to HPRW PAC and mail to: Ms. Susan Pierce, HPRW Treasurer, Dues Received by: ____________________________________ Date: _____________________ Pol Adv paid by HPRW PAC Contributions not deductible for Federal Income Tax purposes. Corporate contributions not permitted.
2010 Membership Form
The Houston Professional Republican Women PAC is a federated organization of the Texas Federation of Republican Women and the National Federation of Republican Women. Our members are professional women and men in many fields – all interested in educating themselves about the political process and in providing strength and unity for political action within the Republican Party of Texas.
Precinct Chair?: ______Yes ______ No
Possible Chair?
Tel: 281-334-4839
FAX: 713-229-5701
Internet: Spierce@hunton.com