Mail this form with your $35* check, payable to Dallas Downtown Republican Women’s Club, to

Mary Silva, PAC Treasurer, 5806 Azalea Lane, Dallas, TX 75230-3402

 

 

Name____________________________________________________________________      

                  Last                     First  Middle Initial               Spouse     

Address
__________________________________________________________________
Street        City                  Zip (9 Digits)

 

     
Telephone
_______________________________________________________________

  Home - Area Code/Number  Work - Area Code/Number

 

             Occupation _______________________________       
(Required by Texas Ethics Commission)

 

 

              Fax ________________________________  

Email
__________________________________

                                                                                      

 

 

Is DDRWC your primary (voting) club? ____ 

Pct No. ____ Sen. Dist. ___ Cong. Dist. ___

 

*Annual membership dues for Associate Members (Republican men or members of other federated Republican women’s clubs) are $15. ___

 

Political Advertising Paid for by Dallas Downtown Republican Women’s Club