Event registration form

The * denotes a required field.

First Name *

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Last Name *

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Best Phone to reach you *

Any normal format of a 10-digit phone number will do.

Email *

Please enter a valid email address.

Dinner *

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Please select the tickets you wish to purchase.

LRW Members Having Dinner

none 1 - $18.002 - $36.003 - $54.004 - $72.00
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Non-members Having Dinner

none 1 - $24.002 - $48.003 - $72.004 - $96.00
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Attendees NOT wanting dinner

none 1 - $10.002 - $20.003 - $30.004 - $40.00
Invalid Input

So we can print up name tags, please type the names of people you are bringing. Tell us anything else here too.

Message

Please limit your special characters to standard punctuation.

Payment Method

On-line now at Event (check, cash, or credit card)

Select "On-line now" and receive a 5% discount. The total below will not show the discount because you will see the discount applied at the LRW PayPal site where you can pay by credit card or your own PayPal account. (Refund Policy is below.)

Logged in

NO YES
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Let us know you are human!*

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Total

$0.00

Become a Member! LRW Membership Cost is $25 per year for Full Membership and $15 per year for Associate Membership. Associate Memberships are available to women who have full membership in another Republican Women's Club and to men who wish to support our cause and attend events. Sign up here.

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