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2012 REGISTRATION FORM3 by HC120627014225


									            Register to Attend the 2012 Republican
Thank you for registering to attend the 2012 Idaho Republican Party State Convention
               June 21-23 at College of Southern Idaho in Twin Falls
          Please return this form with your check payable to the Idaho Republican Party, P.O. Box 2267,
                  Boise, ID 83701. To use a credit card, please complete the form at the bottom.

NAME(S): ___                                          EMAIL ADDRESS:                    ________
CITY/STATE/ZIP:                                                            PHONE:
OCCUPATION:                                           EMPLOYER:

County ___________________ District _____________            Arrival Date_________________

Committee Preference: Indicate your 1st, 2nd, and 3rd choice: Credentials____ Platform_____ Resolutions____
Rules____ (Note: Each delegation selects its own convention committee representatives).
                                                                           REGISTRATION AT THE DOOR IN
                                                                                 TWIN FALLS WILL BE
CALCULATE YOUR OWN COST:                                                  $100/PERSON. PLEASE REGISTER
______ Tickets for Quota paid Counties x $50ea = $______

______ Tickets for Non Quota paid Counties and Guests x $75ea = $_____

______ Saturday Republican Women’s Breakfast x $25ea = $______

TOTAL – PLEASE REMIT THIS AMOUNT                $___________

Name as it appears on card:
 Visa  Master Card       American Express
Account Number:
Amount to Charge:
Expiration Date:                                            Signature:

Paid for the Idaho Republican Party. P.O. Box 2267, Boise, Idaho 83701. Not authorized by any candidate or
candidate committee. Contributions to the Idaho Republican Party are not deductible as charitable contributions for
federal income tax purposes. Contributions from foreign nationals are prohibited. Federal election law requires us
to report your name, address, occupation and employer.

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