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COALITION FOR A CONSERVATIVE MAJORITY
Denver Chapter |
APPLICATION FOR MEMBERSHIP
NAME: _________________________
_______ ___________________________
(First)
(MI)
(Last)
ADDRESS:
______________________________________________________________
(No. & Street or P.O. Box)
______________________________________ ____ __________________
(City or town)
(St) (ZIP)
TELEPHONE NOs: __________________________ ____________________________
(primary)
(backup - work or cell phone)
E-MAIL ADDRESS:
________________________________________________________
Primary
Areas of Concern: (check all that apply)
| ___ Social/Cultural Issues |
___ Media Issues |
| ___ Economic Issues
(fiscal/monetary policies, taxes) |
___ Big Government |
| ___ National Security/Military
Issues |
___
Education |
| ___ Energy and the Environment |
___ Gun Control |
| ___ Other (specify)
__________________________ |
___ Gov't Transparency |
Experience or special skills: (check all that apply)
___ Political Activities (held office, campaigned, attend
rallies/conventions, etc.)
___ Media
Activities (letters to the editor, press releases, interviews/appearances)
___ Fund
Raising
___ Public
Speaking
___ Other
(specify)_________________________________________________ |
| Annual Dues: $52.00* (Not applicable to college
students) |
| ____ Check here if
college student Name of school _______________________ Master Card/Visa/Discover - Name on Card
_______________________________
Card Number __________________________ Expiration Date
_______________
Bring completed form to the monthly
meeting or mail to:
DONNA AYDELOTT, 7898 S. Zante Ct., Aurora, CO 80016
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