Name:__________________________________________________________________
Street Address:__________________________________________________________
City/State/Zip: ___________________________________________________________
County of Residence: _____________________________________________________
Telephone Number:_______________________________________________________
FAX Number:____________________________________________________________
E-Mail Address:__________________________________________________________
Individual : $20.00
Family : $35.00
Student (Ages 18 to 25): $10.00
Century Club: $100.00 (Includes 1 ticket
to Lincoln/Reagan Dinner)
Silver Membership: $125 (Includes
1 ticket
to Lincoln/Reagan Dinner)
Gold Membership: $150 (Includes 2 tickets
to Lincoln/Reagan Dinner)
Platinum Membership: $200 or more (Includes 2 tickets
to Lincoln/Reagan Dinner)
Mail To:
Membership Chairman
Iosco County Republicans
910 East Bay Street
East Tawas, MI 48730-0283
Revised: