Official NKCRC Membership Request Filing Form – New Kent County Republican Committee

Name *

Registered Physical Address *

City *

State

ZIP Code *

Mailing AddressUse only if different than the physical address

City

State

ZIP Code

Email Address *

Cell Phone *

Home Phone

Select Voting District *

Employer *Required by state code for financial reporting purposes.

The NKCRC uses email, phone and text as a means of communication with its members.

City

State

ZIP Code

Occupation *Required by state code for financial reporting purposes.

I hereby apply for :Membership (voting member, attendance and participation required)Associate Membership Application (Non-voting member, no attendance required)

As a voting member, participation in at least one of the following is required. Check all that apply.FundraisingEvent VolunteerMeeting check in/registrationNeighborhood EngagementSign DistributionElection Day operationOther:

Signature *

Date

The NKCRC uses email, phone and tet as a means of communication with its members.