Join NIRW and be part of the solution!! Annual membership rates:
Full Regular Membership - $40.00 Associate Membership (men) - $20.00
Patrons - Gold: $1,000 Silver: $500 Bronze: $250 Other: _______
Northern Illinois Republican Women (NIRW) Membership Application (Please print)
Name _______________________________________________________ Date _____________________
Mailing Address ________________________________________________________________________
City & State ___________________________________________________ Zip Code + 4 _____________
Home Phone _________________________Work ____________________ Cell _____________________
E-Mail ________________________________________________________________________________
(Please PRINT your e-mail address clearly and notify us of changes. This is our preferred means of communication.)
Application Type: New_____ Renewal _____ Annual Dues: Member (women) $40 & Associate* (Men) $20
(*Women with active membership in another Federated RW club and Republican men)
TOTAL ENCLOSED $ ____________ Check # __________ Cash __________
I am a registered REPUBLICAN and I will support Republican ideals and encourage loyalty to the Republican Party.
Signature: _____________________________________________________________________________
How did you find us? Referred by: _________________________________________________________
COMMITTEES INTERESTS: Please indicate the area(s) in which you have an interest!
Literacy _______ Campaign Activities _______ Community Outreach/Service _______
Fundraising _______ Legislative _______ Hospitality _______ Membership _______
Publicity/Media _______ Caring for America (Support Troops) _______ I can help where needed _______
Special talent (graphics design, website, database, editing, writing, etc.) ______________________________
Issues that concern you _____________________________________________________________________
Complete this application and return with your check made out to NIRW...and...mail to NIRW President, Gloria Cardenas Cudia, 409 - 27th Street, Rockford, IL 61108. Thank You!! (www.NIRW.org) 2022
Full Regular Membership - $40.00 Associate Membership (men) - $20.00
Patrons - Gold: $1,000 Silver: $500 Bronze: $250 Other: _______
Northern Illinois Republican Women (NIRW) Membership Application (Please print)
Name _______________________________________________________ Date _____________________
Mailing Address ________________________________________________________________________
City & State ___________________________________________________ Zip Code + 4 _____________
Home Phone _________________________Work ____________________ Cell _____________________
E-Mail ________________________________________________________________________________
(Please PRINT your e-mail address clearly and notify us of changes. This is our preferred means of communication.)
Application Type: New_____ Renewal _____ Annual Dues: Member (women) $40 & Associate* (Men) $20
(*Women with active membership in another Federated RW club and Republican men)
TOTAL ENCLOSED $ ____________ Check # __________ Cash __________
I am a registered REPUBLICAN and I will support Republican ideals and encourage loyalty to the Republican Party.
Signature: _____________________________________________________________________________
How did you find us? Referred by: _________________________________________________________
COMMITTEES INTERESTS: Please indicate the area(s) in which you have an interest!
Literacy _______ Campaign Activities _______ Community Outreach/Service _______
Fundraising _______ Legislative _______ Hospitality _______ Membership _______
Publicity/Media _______ Caring for America (Support Troops) _______ I can help where needed _______
Special talent (graphics design, website, database, editing, writing, etc.) ______________________________
Issues that concern you _____________________________________________________________________
Complete this application and return with your check made out to NIRW...and...mail to NIRW President, Gloria Cardenas Cudia, 409 - 27th Street, Rockford, IL 61108. Thank You!! (www.NIRW.org) 2022
