Cobb County Republican Party

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					Cobb County
Republican Party
Annual Contribution Form
We encourage your participation at one of the following six levels of support; please indicate your
preference:
____ $ 1,000
____ $ 500
____ $ 250
____ $120 The ‘Cobb 100’ in support of the Cobb GOP office
____ $ 100 Century Club
____ $ 35 Annual Supporter
____ Add $8 to your contribution if you would like a personal Cobb GOP nametag
       Name as you would like it to appear:__________________________________
 _____ Other Contribution.

Mail this form and make your contribution payable to:

The Cobb County Republican Party
Attn: Membership Chairman, P.O. Box 1542, Kennesaw, GA 30156.
Name: ______________________________________________________ Date:_____________

Spouse Name:________________________________________________

Address:______________________________________________________________________

City: _____________________________________ State: _______ Zip:_______________

Telephone #(s): (home) ___________________ (cell) __________________________

E-mail address(es):______________________________________________________


Please let us know your interests in working with the Cobb GOP:

___ Legislative issues; ___ County Commission; ___ School Board; ___ Membership; ___
Newsletter:_____ Events; ___ Fundraising; ___ Telephoning; ___ Rules;___ Headquarters
Volunteer; ___ Election Day Volunteer; ___ Computer Work; ___ Campaigns; ___ Credentials
and Ethics; ___ Communications & Information;___ Military & Veterans Affairs; __ Hispanic
Outreach; ____ (other ) ___________________________________

                       Thanks for supporting the
                     Cobb County Republican Party!