Membership Application

Membership Application

 Republican Party of Dodge County 2017 Membership Application

Today‘s Date _______/_______/_______



Address ______________________________________________________________________

City ___________________________________________State _______ Zip ________________

Home #: _______________________________  Cell Phone#:__________________________________

E-mail* ___________________________________________________

Where Do You Vote? Ward/Municipality__________City_______________Township____________Village______________

List memberships in other political parties or committees___________________________________

Please call Karen Gibson (920-386-3602) if you are interested in becoming a Poll Worker, Poll Observer in your municipality or if you are considering running for any local, state or national office(s).  We have training available.  Are you interested in volunteering to help at events, parades, fair booth, picnic, distributing signs/literature, phone calls? YES____ no______  List your choices and we will contact you: ________________________________________________________________________________________

Membership Choice

Young Republicans age 22 and under:___ $0;  Single: ____ $15 ;   Couple:  ____ $25 ;    Family:  ____  $35    Sustaining: ____ $100 ;   Lincoln: ____ $250 ;   Reagan:____ $500;  Priceless:_____Over $500

Make checks payable to: Republican Party of Dodge County and send to:

RPDC Treasurer, W3855 Hilltop Road, Neosho WI 53059

****Please note:  NEW memberships must be paid 30 days in advance of the Next Year's Winter County Caucus to allow voting at any county caucus, district caucuses, meeting or conventions.

Election laws also require us to obtain the following information from you:

Employer Name and Address: ___________________________________________________________________________________ 

Your Occupation _________________________________________________________________

Welcome to the Republican Party of Dodge County! We look forward to working with you for a more conservative government!

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Contact for Information

Christine Breitkreutz



Grace Degner
Membership Chairman