Patrons Program Application
r New Patron r Renewing Patron
Name_______________________________________________________________________
Address_____________________________________________________________________
City_______________________________________ State ___________ Zip______________
Home Phone_______________________________ Fax_______________________________
Email_______________________________________________________________________
Name of Employer____________________________________________________________
Occupation__________________________________________________________________
(This information must be furnished for federal reporting purposes)
Date__________ Primary Club___________________________________________________
r Enclosed is a check for $250.00
r Enclosed is a check for $125.00, the first of two payments
r Enclosed is a check for $62.50, the first of four payments
Please make checks payable to
Texas Federation of Republican Women
Send checks to:
Texas Federation of Republican Women
900 Congress Avenue * Suite 300
Austin, TX 78701
POLITICAL AD PAID FOR BY
TEXAS FEDERATION OF REPUBLICAN WOMEN, PAC
TFRW, 900 CONGRESS AVENUE, SUITE 300, AUSTIN, TEXAS 78701