SCV Congress of Republicans Membership Application
(from www.scvcr.org)

1. Please fill in requested fields, print and sign:

Name

Address

City / State / ZIP Code

Phone

E-mail

Occupation

As a registered Republican voter, I agree with the purposes and the objectives of the California Congress of Republicans and SCV Congress of Republicans, the chapter to which I hereby apply for membership.

Signature _______________________________________________

Date ________________________

2. Mail printed application and $25 check to:

SCV Congress of Republicans
P.O. Box 803193
Santa Clarita, CA 91380

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