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Fill and Sign the Sport Psychology Informed Consent Form Printable

Fill and Sign the Sport Psychology Informed Consent Form Printable

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BAY AREA REPUBLICAN WOMEN’S CLUB MEMBERSHIP APPLICATION Membership Dues for Current Year Name: November 1, 2013 through October 31, 2014 _________________________________________________________________________________________________ (Please Print) First Middle Last Occupation: _____________________________________________________(Information Required by Texas Ethics Commission) Spouse’s Name: ____________________________________________ (If Applicable) Birthday________________________ Month / Day Address: ____________________________ ________________________ _________________ _______________-________ Street or P. O. Box City State Zip plus 4 digit extension Telephone: Home: (________)____________________________________ Office: (________)____________________________________ Fax: (________)____________________________________ Mobile or Pager: (________)____________________________________ E-Mail: ________________________________________________(Information Requested by BARW & TFRW) County & Voting Precinct #: (BARW By-Laws Article IV,Sect.1) Precinct#_______ Brazoria County Precinct # ________ Galveston County Precinct #________ Harris County Type of Membership: _________$ 25.00 Full Membership for Women _________Renewal __________New Member . __________$ 15.00 Associate Membership RWC Members _________Renewal ____________New Member Name of RWC Full Membership:_________________________________________________ . ___________$ 15.00 Associate Membership for Men Areas of Interest: _____Literacy _____Legislative __________Renewal . _____Campaign Activities ____________New Member ______Fundraising ______Events ______Membership ______Telephone ______Publicity ______Community Service Other: ___________________________________________________________________________________ ______________________________________________________________________ Please Make Checks Payable to: BARW-PAC Date: __________ (INCORPORATED CHECKS ARE PROHIBITED) For Information Call: Rae Sinor at 281-923-5433 Amount Paid: _________ Check # __________ Send to: Lynn Osina Treasurer, BARW 16856 Royal Crest Drive Houston, TX 77058

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