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Greater Peninsula Republicans E-member form
Please complete our GPYR membership form. We will keep you in the loop of upcoming events and meetings. We hope to see you soon!
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First Name
*
Your answer
Last name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Street name
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Email
*
Your answer
Mobile number
*
Your answer
Congressional District?
Your answer
Virginia House District?
Your answer
Virginia Senate District?
Your answer
Date Signed
*
MM
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DD
/
YYYY
Membership Dues paid?
*
Yes
No
I will pay at the next meeting
Associate member? (under 18 years old or over 40 years old)
*
Yes
No
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