Hrcmc Hispanic Republican Club Of Mclennan County Memebrship Form

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ME MBE RS HI PF ORM APPL I CANTI NF ORMAT I ON Na me : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Da t eofBi r t h: _ _ _ _ _ / _ _ _ _ _ / _ _ _ _ _ _E ma i l : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone # : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Cur r e ntAddr e s s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ci t y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _S t a t e : _ _ _ _ _ _ _ _ _ _ _ _Z i pCode : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ce l l Phone : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _F a x : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Bus i ne s s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E MPL OY ME NTI NF ORMAT I ON S e l fE mpl oy e d? Y e s/No I fY e s , Na meofBus i ne s s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I fNo, Na meofE mpl oy e r : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Oc c upaon: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PE RMI S S I ONS Ca nwepr ov i dey ouri nf or maont oc a ndi da t e swhe na s k e d? Y E S/NO Ca nwee ma i l ne ws l ee r sa ndot he rc l ubr e l a t e di nf or maont oy ou? Y E S/NO Ca nwepos ty ourc ont a c ti nf or maoni nt hepa s s wor dpr ot e c t e da r e aofourwe bs i t e ?Y E S/NO S POUS EI NF ORMAT I ONI FAS S OCI AT EME MBE RS HI P S pous eNa me : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Oc c upaon: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ VOL UNT E E RI NF ORMAT I ON I woul dl i k et os e r v eont hef ol l owi ngc ommie e s : _ _T e l e phone_ _ F undr a i s i ng _ _Me mbe r s hi p_ _Pr og r a ms _ _Ca mpa i g nAcv ie s _ _Re s e a r c h&L e g i s l av e _ _Hos pi t a l i t y _ _Communi c aons _ _We bs i t e _ _Ne ws l ee r_ _Ot he r : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Annua l Re g ul a rMe mbe r Annua l Re g ul a r+As s oc i a t e Pl e a s ec ompl e t et hi sa ppl i c aona ndr e t ur nwi t hy ourc he c kma depa y a bl et o: “ HRCMC”Ma i l t o: Hi s pa ni cRe publ i c a nCl ubofMc L e nna nCount y : P . O. Box AmountE nc l os e d:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Da t e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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