Official NKCRC Membership Request Filing Form Name *Registered Physical Address *City *StateZIP Code *Mailing AddressUse only if different than the physical addressCityStateZIP CodeEmail Address *Cell Phone *Home Phone *The NKCRC uses email, phone and text as a means of communication with its members.Select *Tunstall – Hopewell BaptistSouthern Branch – Providence United Methodist ChurchQuinton – St. Elizabeth Ann Selton ParishKentwood – Kentwood Heights Baptist ChurchWatkins – George W. Watkins Elementary SchoolCumberland – New Elam Baptist ChurchProvidence Forge – Providence Forge Recreation Association BuildingMountcastle – Mt. Cavalry Church InternationalEltham – Parham Landing Commerce ParkChickahominy River – Ebenezer Baptist ChurchNot sureEmployer *Required by state code for financial reporting purposes.Occupation *Required by state code for financial reporting purposes.Consent *I am a legal and qualified voter of New Kent County, under the laws of the Commonwealth of Virginia, who is in accord with the principles of the Republican Party, and who attests by my signature below my intent to support all of its nominees for public office in the ensuing election. I have not participated in Virginia in the nomination process of a party other than the Republican Party in the last five years, but if I have, I now renounce affiliation with any other political party.I agree to pay a $10.00 non-refundable fee to the NKCRC and I have read and understand the attendance policy (Article II, Section D. Absenses) set forth by the Republican Party of Virginia.Signature *Start signing your signature hereYour browser does not support e-Signature field. *The NKCRC uses email, phone and tet as a means of communication with its members.Submit Request
