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Full Name *

Address *

Cell/Home Phone Number *

Email *

Membership Eligibility *

• Must be registered Republican for at least one (1) year and in good standing
• Must support the mission and values of the Republican Party

Have you been registered Republican for more than 1 year? *

• Yes
• No

Fees *

• Personal Annual Dues $25.00
• Other Donation

1 year? you

How can you help? *

• Membership
• Refreshments/snacks
• Events
• Grassroots
• Media/tech
• Other

Please check all that apply.

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After submitting your registration, please make your check payable to Republican Latino’s Coalition*

Mail to: Shawn May 4047 Mariner Blvd. Spring Hill, FL 34609

*Any dues paid are non-refundable.