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:
Bloomfield RWC ATTN: 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____________________________
Business Phone _____________________
E-Mail:_________________________________
Please designate:
Circle One: I DO/I DO NOT want to receive information via e-mail.
Circle One: I GIVE my permission to publish my email in the 2012 Directory
I DO NOT give permission to publish my email in the Directory
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:____________________________
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