Please print this page, complete the form and mail to the address below.
ACADIANA REPUBLICAN WOMEN
www.acadianarepublicanwomen.com
The 2003 dues of the Acadiana Republican Women (ARW) are $30.00. Out of that, the club pays your dues to the Louisiana Federation and the National Federation of Republican Women.
______ Associate Member (Republican men or Non-Republican woman or man)
Please print.
First Name: _____________________________
Last Name: _____________________________
Address: _____________________________
_____________________________
_____________________________
(City, State and Zip)
Home: _____________________________
Work: _____________________________
Fax: _____________________________
E-mail: _____________________________
Precinct: _____________________________
Council District: _____________________________
School Board: _____________________________
State House District: _____________________________
Senate District: _____________________________
Mail to Membership Chairperson:
301 Leonpacher
Lafayette, LA 70508