Republican Party of MN Elephant Club

Become A Member Of The Elephant Club

First name:	MI: Last name:
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Address2:
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Home Phone:
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Email:	* * * NOTE: please make sure your email address is correct -- you will receive important confirmation notice at this address
CREDIT CARD INFO

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Expires:
YES, I WANT TO JOIN THE
	Elephant Club - $1000 Young Elephant Club (under age 40) - $500 Please Bill Me: Annually Quarterly Monthly
EMPLOYMENT INFORMATION
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CONFIRM YOUR ELIGIBILITY
	By checking this box, I confirm that the following statements are true and accurate: I am a citizen or permanent resident in the United States. The funds I am contributing are my own personal funds and not those of another person. My contribution is not from the general treasury funds of a corporation, organization or national bank. I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through a corporate or business entity card or the card of another person.