ASSOCIATE MEMBERSHIP APPLICATION | www.southbayrepublicans.com

Associate Member Program Application

Name of Registered Voter

FIrst Name

Last name

Registered Voter Address

Registered Voter Address Line 2

City

Zip Code

Phone

Business Name and/or Title

College Student Membership Fee: $25

Associate Membership Fee: $50

Individual Associate Member Charter Fee: $100

Public Official Associate Member Charter Fee: $100

Confirm Your Eligibility:

YES: I am a citizen or permanent resident in the United States. _ The fund I am contributing are my own personal funds and not those of another person. I am not a foreign national who lacks permanent resident status in the United States. - I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through the card of another person. - I am at least 18 years of age. - I agree and confirm that the above statements are true