2012 Membership Dues:       $30.00

Please fill in the form below (the info you give will be put in our directory) and send it with your check payable to Bloomfield RWC to Membership Chair as follows:

Marjorie Biglin

5863 Cliffside Drive

Troy, MI 48085

Questions?     Call: 248-879-9494 

                        E-Mail: mrsbig@wideopenwest.com

Member Information: _______ I am a returning member   _______I am a new member

Name__________________________________Spouse__________________________                  

Address_______________________________________________________________

City, State, Zip_________________________________________________________

Home Phone_____________________Cell____________________________ 

E-Mail:_______________________________

            Circle One: I DO/I DO NOT want my e-mail published in the Directory.

Circle One: I DO/I DO NOT  want to receive periodic updates about Bloomfield RWC events on

                   e-mail via our new e-Communications service.

IN ADDITION to my membership dues, I am enclosing __$25 __$50 __$75 to help the Bloomfield Republican Women’s Club continue to spread the conservative message.

Republican Women’s Club Memberships:

If you are a member of another Republican Women’s Club, you must be a voting member in only one club, and an associate member of the other clubs.  Please indicate below whether you would like to be a voting member in this club, and list any other Republican Women’s Clubs of which you are a member.

Please check one:

I would like to be a ____ voting member _____ associate member in the Bloomfield RWC.

Please list any other Republican Women’s Club in which you are a member ____________________

Volunteer Opportunities

I will volunteer for:

_____ publicity ____ mailing ____ telephone ____ serve on board ____ hospitality ____ newsletter

____ work on club directory _____ serve on committee   Other abilities:____________________________