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.

Please provide the following information:

Name: _____________________________________  Spouse: ________________________________­­­­

Street Address: _____________________________  County of Residence: _____________________
City:____________________ST_____ZIP: ________ Voting Precinct: _________________________
Occupation:________________________________   Registered Voter:   ______Yes      ______ No
                                                                       Precinct Chair?:      ______Yes      ______ No  

Home Phone:

__________________

Office Phone:

__________________

Cell:

__________________

Office Fax:

__________________

E-mail Address: ______________________________________________________________________

Preferred Method of Communication:    Email        Snail Mail        Home Phone         Office Phone

2012 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?

Possible Chair?

Board Position

Campaigns/Issue Research

Community Service

Programs

Publicity

Social

Ways & Means

Please make your check payable to HPRW PAC and mail to:

Ms. Cynthia England, HPRW Treasurer, 4544 Post Oak Place Dr., #125, Houston TX 77027

Dues Received by: ____________________________________          Date: _____________________

Pol Adv paid by HPRW PAC Contributions not deductible for Federal Income Tax purposes. Corporate contributions not permitted.

Houston Professional Republican Women
4544 Post Oak Place Dr., #125, Houston TX 77027
 Tel: 713-622-9825 
FAX: 713-622-9844 
Internet: Clengland@sbcglobal.net