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About
Membership
Facilities
Contact Us
- Location
- Club Staff

Membership Form

APPLICATION

To the Membership Committee:

I have been proposed as a (check one)

	Resident
	Non-Resident
	Junior Plan A
	Junior Plan B
	Associate
	Junior Associate Plan A
	Junior Associate Plan B
	Senior
	Life
	Student
	Military
	Clergy Member of the Women’s National Republican Club

If elected, I agree to abide by the requirements of the Club’s House Rules and By-Laws.

Full Name *

(please indicate Mrs., Ms., Dr., Mr., Other)

Residence Address

Apt. Number

City

State

Zip code

Home Phone

Fax Number

Cell Phone

E-Mail

Are you a citizen of the U.S.?

Place of Birth

Date of Birth

Are you a Registered Republican?

(Proof of age required for Junior and Senior status)

Educational Background:

Summary of Professional Career:

Club Affiliations (positions held if applicable):

Other Activities (volunteer work, charitable affiliations, hobbies, etc.):

Please write a few comments stating why you would like to join.

How did you hear about the Club? *

Do you intend to use the Club primarily for personal or business purposes?

Signature *

Date

** Please note that the Non-Refundable Initiation Fee of $544.38 must be included when submitting your Membership Application. Not applicable to Junior Membership Categories

FIRST PROPOSER

Proposer’s Name:

Member Number:

How long have you known the candidate?

Reasons for proposing the candidate:

How long have you been a member?

Signature *

Date *

SECOND PROPOSER

Proposer’s Name:

Member Number:

How long have you known the candidate?

Reasons for proposing the candidate:

How long have you been a member?

Signature *

Date *

3 West 51st Street, New York, NY 10019
Tel: (212) 582 5454 | Fax: (212) 265 5633 Email: [email protected]
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