Family___ , Individual___ , Business or Corporation___. (check one)
NAME:__________________________________
Address: ________________________________
City: ____________________ Zip____________
E Mail:__________________________________
Phone # H ___ ___ ____ , Cell# ___ ___ ____
Work#: ___ ___ ____ , FAX#: ___ ___ ____
Information: If you would like to get involved with our growing party here in Walton County, just check the box below for your area of interest :
__ WILL HELP IN CANVASSING/POLLING
___ WILL HELP MAKE PHONE CALLS
___ WILL HELP WITH COMPUTER MEMBERSHIP LIST FOR COUNTY
___ INTEREST IN RUNNING FOR PUBLIC OFFICE
___ INTEREST SERVING AS A DELIGATE TO COUNTY/ STATE CONVENTION
___ OTHER.
Comments: ___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Annual Dues
$25.00 Individual, $50.00 Family , $100.00 Business/ Corp, $350.oo Patron
TO PRINT THIS FORM, HOLD YOUR CONTROL KEY DOWN AND HIT CONTROL P, YOUR FORM WILL THEN PRINT, OR YOU CAN COPY AND PASTE AND E MAIL TO
MAIL COMPLETED APPLICATION TO:
ROY N. ROBERTS
P.O. BOX 390
MONROE,GA. 30655
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