Georgia Young Republicans of Henry County

Please Print The Application Fill it out and Mail it to: 778 South Bethany Road Mcdonough, Georgia 30252

Or if you prefer you can print and scan it and e-mail it to mailto:thomascashon@gyrhc.org

  Young Republicans of Henry County

Membership Application

Name: ______________________________________________________

Birth date: _______________________

Address: __________________________________ City: _________________ Zip:

__________________

Home Phone:    ______________________________ Work: ______________________

E-Mail: ____________________________

Precinct/VotingLocation_____________________

Occupation (optional): _________________________   Employer____________________

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Committee Information(Please check areas of interest)

Officer in YR’s _____   Membership _____   Fundraising _____          Social   _____ Communications ____ Website ____ Campaign Coordinator ____ Community Outreach ___

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Annual Membership Dues

___      Member (Voting/Sustaining) - $12 per year

___      Associate Member (member of other YR chapter) - $10 per year

___      Meeting Sponsor - $50 Suggested Minimum Contribution

___      Chairman’s Club Member - $100 Minimum Contribution

Date paid: ___________________________

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The Georgia Young Republicans of Henry County utilize e-mail as an economical and effective method of communication. If you prefer to receive communications via postal service or telephone, please indicate: Postal ____   Telephone: ____ (home or work?)

UNTIL AN ACCOUNT IS OPEN PLEASE PAY ALL DUES IN CASH