Please print the following application and mail it to us
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2005 MEMBERSHIP APPLICATION
www.eastaustinrepublicans.org EAST AUSTIN REPUBLICANS
NAME:_____________________________New:_____ RENEWAL:__________________
BIRTH DAY (MM/DD):__________SPOUSE:___________________________________
MAILING ADDRESS:______________________________________________________
CITY & STATE:______________________________ ZIP:______________________
OCCUPATION:___________________________________________________________
*Required by law for Political Action Committees. If not employed
*outside of home: retired, private tutor, homemaker, volunteer, etc.
PRECINCT #:_____________________ SUBDIVISION:________________________
HOME PHONE:_____________WORK:_________________ CELL:_________________
FAX:____________________EMAIL:_______________________________________
: Please notify us of email changes
as this is our preferred means of
communication.
________ACTIVE MEMBER - $25 $_________- EAR DONATION
TOTAL ENCLOSED: $_______CHECK NO.:___________CASH:__________________
COMMITTEES/INTERESTS: PLEASE INDICATE THE AREA(S) IN WHICH YOU HAVE
AN INTEREST.
_______ COMMUNITY OUTREACH ______CAMPAIGN ACTIVITIES
_______ CARING FOR AMERICA (SUPPORT OUR TROOPS) ______COMMUNITY SERVICE
_______ FUNDRAISING ________HOSPITALITY ______LEGISLATIVE LIAISON
_______ MEMBERSHIP _________PUBLIC RELATIONS ______HELP WHERE NEEDED
ISSUES THAT CONCERN YOU:______________________________________________
______________________________________________________________________
______________________________________________________________________
I WOULD LIKE TO RECEIVE EAR HOTLINE UPDATES BY: _____ EMAIL _____ FAX
PLEASE RETURN COMPLETED APPLICATION WITH YOUR CHECK OR MONEY ORDER MADE TO:
EAST AUSTIN REPUBLICANS
MAIL TO: Rudy Phillips, MEMBERSHIP CHAIRMAN
EAST AUSTIN REPUBLICANS
P. O. BOX 140023
AUSTIN, TEXAS 78714
EMAIL RUDY AT:ruddyphillips@yahoo.com
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