BCYR Online Membership Information Form Directions: fill in the fields, print, sign & date printout, and bring to next meeting/social.
Name: Birthday: Address: City: State: Zip Code: Home Phone #: Work #: Cell Phone #: E-Mail: Precinct # (found on voter i.d. card): Interests (check all that apply): Political Social Volunteer Internet Newsletter PAC How You Found Out About BCYRs: Joined/Renewed as a Single or Couple? single $25 couple $35 Spouse's Name (if applicable): Sign: _______________________________ Date: _____ Spouse's Sig (if appl.): ________________________ Date: _____
