Tennessee Republican Assembly
Membership Application

Name: _________________________________________________

Address: _______________________________________________  Apt./Suite: _______________

City: __________________________   State: ___________  Zip: _________________

Phone: _________________________  Fax: ___________________________

E-mail: _______________________________________

Would you like to be added to the TRA e-mail mailing list (Yes/No): _______________

County: _______________________________________

Special interests or ability: _________________________________________________________

Annual Memberships
Regular Member -- $10.00
Sustaining Member -- $50.00

Make check payable to: Tennessee Republican Assembly