THE REGENTS / CAPITOL REGENTS

National Federation of Republican Women ~ 124 N. Alfred Street ~

Alexandria, VA 22314-3011 ~ (703) 548-9688 ~ FAX: (703) 548-9836

·        NFRW Regents are members of a powerful group of Republican activists.

·        NFRW Regents include Members of Congress, top executives and community leaders.

·        NFRW Regents combine personal and civic activism with the desire to promote the cause of good government at the national level.

·        NFRW established the Regents Program more than 20 years ago as an avenue for Republican women to play a greater role in our nation's political system.

·        NFRW Regents support a wide range of political education programs.

·        NFRW Regents provide operating capital which allows the NFRW to maintain a low general membership rate, making membership affordable to women of all ages and economic backgrounds.

·        NFRW Regents membership is reserved for individuals who wish to make a commitment of $1,000 annually to the NFRW. Many women wishing to go beyond the initial commitment have become Capitol Regents. Capitol Regents make the commitment of $5,000 annually to the NFRW.

□ I want to become a Regent/Capitol Regent of National Federation of Republican Women

□ Membership Renewal      □ Payment Plan

Name __________________________________ Business Name ___________________

Home Address ____________________________________________________________

City _______________________________________ State ___________ Zip __________

Home Phone ________________________ Work Phone __________________________

Fax __________________________ E-mail _____________________________________

For Secret Service Clearance - Date of Birth ____________ S.S.# ___________________

Are you a unit club member? □ yes □ no

If so, name of club: _________________________________________________________

□ I am enclosing a check for $1,000                     □ I am enclosing a check for $5,000

□ Semi-annually, enclosing a check for $500       □ Quarterly, enclosing a check for $250

Please charge my Regents commitment to my ___ Visa ___ MasterCard

_______________________________ _________________________________________

(credit card number expiration date amount)

Signature ________________________________________________________________

Please complete this form and mail to:

National Federation of Republican Women

124 N. Alfred Street

Alexandria, VA 22314-3011 or

Fax with credit card info to:  (703) 548-9836