SCG REPUBLICAN GROUP
MEMBERSHIP APPLICATION
Dues: Single $20.00 or Household $35.00
PLEASE PRINT LEGIBLY: All fields MUST be complete.
The completed form can be brought to any general meeting or mailed to:
SCG Republican Party SIG, PO BOX 7842, Surprise, AZ 85374
Questions Contact: Toni Helgeson at 623-680-5507 or meizel1948@gmail.com
DATE: ____/___/______
Payment Type: CASH_________CHECK# __________Payable to: SCG Republican Club
ZELLE using your bank APP: scgrepclub24@gmail.com
First name: SCGrand Last Name: Republican Club
Membership type: NEW______RENEWAL _______ SINGLE ______ HOUSEHOLD ______
MEMBER 1 SCG CAM# (if applicable)________________ SCG RESIDENT: Y_____ N_____
FIRST NAME_____________________________LAST NAME____________________________________
ADDRESS (Local)____________________________________City ________________ZIPCODE________
MEMBER 2 (if applicable)
FIRST NAME________________________LAST NAME____________________________________
Home # ________________________ Cell# 1____________________ Cell#2_________________
Email address Member 1______________________________________________
Email address Member 2______________________________________________
NOTE: All business-related information including meeting notifications are sent out via email. Members email
addresses are for REPUBLICAN PARTY business use only and will not be distributed to non-party organizations. It may
take up to 7 days to deposit check as we only do this weekly.
SCG REPUBLICAN GROUP
MEMBERSHIP APPLICATION
Dues: Single $20.00 or Household $35.00
PLEASE PRINT LEGIBLY: All fields MUST be complete.
The completed form can be brought to any general meeting or mailed to:
SCG Republican Party SIG, PO BOX 7842, Surprise, AZ 85374
Questions Contact: Toni Helgeson at 623-680-5507 or meizel1948@gmail.com
DATE: ____/___/______
Payment Type: CASH_________CHECK# __________Payable to: SCG Republican Club
ZELLE using your bank APP: scgrepclub24@gmail.com
First name: SCGrand Last Name: Republican Club
Membership type: NEW______RENEWAL _______ SINGLE ______ HOUSEHOLD ______
MEMBER 1 SCG CAM# (if applicable)________________ SCG RESIDENT: Y_____ N_____
FIRST NAME_____________________________LAST NAME____________________________________
ADDRESS (Local)____________________________________City ________________ZIPCODE________
MEMBER 2 (if applicable)
FIRST NAME________________________LAST NAME____________________________________
Home # ________________________ Cell# 1____________________ Cell#2_________________
Email address Member 1______________________________________________
Email address Member 2______________________________________________
NOTE: All business-related information including meeting notifications are sent out via email. Members email
addresses are for REPUBLICAN PARTY business use only and will not be distributed to non-party organizations. It may
take up to 7 days to deposit check as we only do this weekly.
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