Membership Form for the Longmont Republican Women

Please fill in the following information. Decide if you would like a Full Membership ($25/year) or an Associate Membership ($10/year). Associate Memberships are available to women who have full membership in another Republican Women's Club and to men who wish to support our cause and attend events. Then, please send your Membership Dues check of $25.00 for a Full Membership or $10.00 for an Associate Membership, made out to "LRW" and mail it to the LRW Treasurer:
Betty Swenson
32 Princeton Circle, Longmont, CO 80503-2106

First Name:      Last Name:  

Street:      City:      State:      Zip + 4 (if you know it)  

Email address:        Precinct (10 digits, if you know it):  

Home Phone :     Cell Phone :  

Type of Membership:  

I prefer to get a friendly meeting reminder by:  

I would like to help the LRW be an effective tool to regain freedom in this country!
My talents include:
Message or special request:
I am a registered Republican and agree to endorse the bylaws and objectives of the CFRW (Colorado Federaton of Republican Women) and NFRW (National Federation of Republican Women).
The CFRW objectives and links to the CFRW and NFRW bylaws (pdf) are on the About Us page.

Security Question: 1 + 7 =  

If you have provided an email address, you will receive an automatic onfirmation e-mail containing the information you submitted.
The LRW President will be contacting you soon to welcome you.