Name:

Spouse Name for family membership: 

Address:

City: State: Zip:

Home Phone:     Cell Phone:

Email Address:

Preferred Method of Contact Email Home Phone Cell Phone Standard Mail Choose One

Voting Precinct:  Voting Precinct Adairsville Allatoona Cartersville East Cartersville West Beavers Drive Cassville Center Emerson Euharlee Folsom Kingston Mission Road Pine Log Taylorsville White Woodland High Zena Drive

  Employer (Required by F.E.C.): 

$25 Level ($40 for 2 years):  Individual Membership & Information Updates

$35 Level ($60 for 2 years):  Household Membership & Information Updates                  

$75 Level ($125 for 2 years):  Household Membership, Information Updates & Sponsor Status in newsletter and website                      

$150 Level ($250 for 2 years):  Household Membership - Silver Sponsor, Information Updates, Sponsor Status in newsletter and website, Bartow GOP Mug & Invitations to Special Events                                

$300+ Level  ($500+ for 2 years):  Household Membership, Information Updates, Sponsor Status in newsletter and website, Link to your website at www.BartowGOP.com, Bartow GOP Mug, Invitations to Special Events & Bartow GOP Hat

I have paid for 2 years

I would like more information before I join. 

I am interested in:
(Select all that apply)

Volunteer My Time     Serve as a Precinct Officer   Attending Monthly Meetings

Assist Candidates With Campaigns    Contributing Financial Donations  

Serve as a Delegate at Conventions   Being Notified of Special Events