Mail your check, payable to: “Madison County Republican Women” and send it, along with this application form *, to:
ATTN: Treasurer
Madison County Republican Women
P.O. Box 314
Madison, VA 22727
Name: _________________________________________________
Phone No: _____________/______________________
Address: ________________________________________________
City/State/Zip: ________________________________
Fax: _________________________________
E-mail:_________________________________________________________
Amount Enclosed: $______________
Check No. _____________________
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