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Lake Havasu Republican Women's Club

MEMBERSHIP APPLICATION
PLEASE COMPLETE A NEW APPLICATION EVEN IF YOUR INFORMATION HAS NOT CHANGED. THANK YOU

LAKE HAVASU REPUBLICAN WOMEN 2025

First Name

Last Name

What Club are you a Voting Member to?

Email

Address

Phone

Summer Address

Badge Name

Birthday

Anniversary

New Member

Renewal

Patron $100.00

Regular Member $40.00

Associate Member $15.00

Name Badge $15.00

After Submission wait for Email Confirmation

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