NIRW
  • HOME
    • CALENDAR
    • ACCOMPLISHMENTS
    • BYLAWS 2019
  • MEMBERSHIP
  • OFFICERS - 2023-2025
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 Gloria Cardenas Cudia, 409 - 27th Street, Rockford, IL 61108.  Thank You!!    (www.NIRW.org) 2024
Powered by Create your own unique website with customizable templates.