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I, ____________________________________, wish to become a member of The Reform Party of Missouri, an existing Mo. political party since 1996 and currently a state party organization affiliate of RPUSA. I disclaim any membership or allegiance to all other political parties, even if using all or part of the same name, and I declare support for the basic issues for which the party is known.
Signature:_____________________________Date ________________________ Printed name:_________________________ Printed FULL ADDRESS, PHONE, FAX, E MAIL: _________________________________________________________________ ____________________________________________________________________ County_____________ Precinct_____________ Ward________Cong. Dist.____________ State Senate Dist.__________ Mo. House Dist.__________ Judicial Dist.______________ Issues you are particularly interested in _________________________________________ You would like to help out with ______________________________________________ Initial membership in The Reform Party of Missouri, approximate date_________________ Membership is FREE, but donations are encouraged. ALL MEMBERSHIPS SHOULD BE RENEWED ANNUALLY ALL CURRENT AND NEW MEMBERS ARE ASKED TO SUBMIT COMPLETED FORM TO: The Reform Party of Missouri 307 W. Fields, Suite 888, El Dorado Springs, Mo. 64744 OR YOU MAY FAX YOUR APPLICATION TO 586-314-0929 or scan into e mail rpmoreform@yahoo.com
In order to participate in the mini conventions membership should have begun at least 30 days by May 30, 2001, but this form may be filled out the day of the mini conventions. The congressional district committee may choose to accept newer members for voting, but must keep tally of said votes separate from the others and report same to the state central committee, which may use the fact in settling disputes or challenges. Removed members may NOT re apply during this eleciton cycle.
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| El Dorado Springs | Missouri | 64744 |
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