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REPUBLICAN PARTY of VIRGINIA BEACH

2955 Virginia Beach Blvd. Suite 105 Virginia Beach, VA 23452 (757) 486-2382
www.RPVB.org

Membership Application/Renewal
Name _______________________________ Date of Birth _____/_____/________
Street Address ________________________________________ Apt./Suite_______
City __________________________ State ___________ ZIP Code ______________
Telephone (____) ______-__________

Cellular (____) ______-__________

E-mail Address ________________________________________________________


Occupation or School Attended ___________________________________________
Membership Options:

Member ($50.00)

Associate

Member ($25.00)

Student Member ($15.00)

Committee Assignment:
In accordance with RPVB Bylaws under Article II, Section I, please insert a check mark below to
become an RPVB Precinct captain or poll worker for our Party.

Precinct Organization
By signing below, I agree to abide by the By-Laws of the City Committee of the Republican Party
of Virginia Beach as well as the Plan of Organization of the Republican Party of Virginia.

_____________________________________________________
Signature
For Internal Use Only:
Date Received:
_____/_____/_______
Precinct:
_______________________
Council District:
__________________
Delegate
District:_________________
VA Senate
District:________________

REPUBLICAN PARTY of VIRGINA BEACH


2955 Virginia Beach Blvd. Virginia Beach, VA 23452 (757) 486-2382
www.RPVB.org

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