Albemarle County Republican Committee Membership Application 2016 Important!!! To complete your application you must use the Donate Button on the right to pay yearly dues using Paypal. Name Street Address City Zip Precinct (where I vote) Home Phone Cell Phone Occupation Employer Employer Address Email Address Sign me up for email newsletters Signup for website updates Membership Levels Your generous contribution will be put to good work to elect our Republican candidates. Please use our secure link in the upper right column for online payments. Thank You Basic Membership $25.00 Red Membership $50.00 Bronze Membership $75.00 Silver Membership $100.00 Gold Membership $250.00 Platinum Membership $500.00 Student Membership $10.00 Other Amount Complementary Memberships are available due to financial hardship. Chair, Please contact Chair, Elliott Harding, firstname.lastname@example.org, (434) 962-8465 for details. Please Volunteer Let us know what activities you are willing to assist . Please check all that apply. Working on mail projects Making Phone calls for candidates Going door-to-door for candidates Working for the party on election day Other volunteer work Events I am interested in attending (please check all that apply). Speeches and press conferences Political rallies Party picnics and dinners The monthly breakfast meetings To Complete your online application you must make payment through Paypal using the ‘Donate’ button below. Please use MasterCard, Visa, Discover, American Express or your PayPal account.