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Iosco County Republicans
Membership Application Form


Street Address:__________________________________________________________

City/State/Zip: ___________________________________________________________

County of Residence: _____________________________________________________

Telephone Number:_______________________________________________________

FAX Number:____________________________________________________________

E-Mail Address:__________________________________________________________

Annual Membership Dues

Individual : $20.00
Family : $35.00
Student (Ages 18 to 25): $10.00
Century Club: $100.00 (Includes 1 ticket to Lincoln/Reagan Dinner)

Silver Membership: $125 (Includes 1 ticket to Lincoln/Reagan Dinner)
Gold Membership: $150 (Includes 2 tickets to Lincoln/Reagan Dinner)
Platinum Membership: $200 or more (Includes 2 tickets to Lincoln/Reagan Dinner)  

Mail To:

Membership Chairman
Iosco County Republicans
910 East Bay Street
East Tawas, MI 48730-0283


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