Henrico County Republican Committee ~ Membership Form

* Denotes required information.

Are You a New or Returning Member? *

First Time Applicant

Renewing Current Member

Past Member

Prefix (Mr./Mrs./Ms./Dr. etc.)

First Name *

Middle Initial

Last Name *

Suffix (Sr./Jr./III etc., if applicable)

Residence Address (must match voter registration) *

Residence Address 2 (if needed)

City *

State/Province *

Zip/Postal Code *

Primary Phone *

*

Home

Work

Mobile

Additional Phone

Home

Work

Mobile

Email Address *

Occupation (required by campaign finance laws) *

Employer (required by campaign finance laws) *

Voter Registration Number (not SSN) *

I would like to participate in the following Party activities:

We use your 9-digit voter registration number to confirm your voter registration status. You may retrieve your voter registration number through the Virginia Citizen Portal on the Department of Elections website, by clicking here. It also appears on your voter registration card.

Dues and Other Information

By signing below, you hereby agree as follows:

Dues payment required: $30 committee dues are due and payable with this submission. You will be taken to the dues payment page after submission of this form. If you pay by check, please make checks payable to the Henrico County Republican Committee and mail them to: Henrico County Republican Committee, PO Box 2424, Glen Allen, VA 23058.

Email authorization: Please send all communications, including meeting notices and meeting calls, to me at my address above. I do not wish to receive paper communications.

Properly completed new member applications received with dues will be voted on at the next official Committee membesrhip meeting. Meetings are posted on our website at www.henricogop.com. You are welcome to attend Committee meetings and functions pending your membership approval.

* After you submit your application, you will be taken to an online payment page in order to pay the annual $30 dues.

Required Republican Membership Pledge
(please check)
*

I certify that I am a registered voter in Henrico County, Virginia and I am in accord with the principles of the Republican Party as stated in the Republican Creed and intend to support the nominees of the Republican Party if elected to membership.

Please sign *

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