COBB COUNTY REPUBLICAN WOMEN’S CLUB
2004 MEMBERSHIP APPLICATION
Simply print this form out from your web browser
_____ Renewal _____ New Member Sponsoring Member _____________________________
$35.00 General Membership $25.00 Associate Membership
$25.00 Student Membership $25.00 General Membership (65 & older)
Name: _________________________________ Spouse_________________________
Address:____________________________ City: __________ State:____ Zip: _____
Phone: (work) _________ (home)___________Fax #__________ E-Mail ___________
Occupation: ________________________ Date of Birth(month & day only) _______
Areas of Interest
Party Participation Public Relations Legislative
_____ Campaign _____ Event Publicity _____ Letter writing
_____ Phone Bank _____ Newsletter _____ Serve on
_____ Election Day committee
_____ Convention Delegate _____ Media Relations _____ Lobbying
_____ Staff GOP Headquarters
_____ Candidates Forum
Membership Fundraising Other
_____ Recruitment _____ Phone Bank _____ Decorations
_____ Hospitality _____ Sponsor solicitation _____ Mail-outs
_____ Food
_____ Scholarships
_____ Socials _____ Awards
Dues are payable on January 1 of each year. Members who have not paid dues by February 1 are considered delinquent.
Sponsorship of our annual Directory and Monthly Newsletter are $25.00 each.
Send membership form and check to:
Would you like to contribute to the Babe Atkins-Byrne Scholarship Fund? If so, please make check payable to CCRWC and indicate for scholarship fund.
Dues ________
Membership Coordinator Sponsor Newsletter ($25
Babe Atkins-Byrne per issue – business card) _______
886 Lake Hollow Blvd. Sponsor Directory $25 ________
Marietta, GA 30064 Name Tag ($10) ________
babeatkinsbyrne@yahoo.com Babe Atkins-Byrne
(770) 425-8122 Scholarship Fund ________
TOTAL DUE ________