Bath County Republican Committee
P. O. Box 132
Warm Springs, Virginia 24484
(540) 996-4422
www.bathrepublicans.org
Membership Application Form
The Bath County Republican Committee is the local unit of the Republican Party. The Committee works at the grassroots level to help elect Republican candidates by assisting with campaign, fundraising, and voter outreach efforts. Committee meetings are held on the 4th Thursday of the month at 6:30 p.m. at the Warm Springs library.
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ________________________________________ State: _________ Zip: ___________________
Phone: ______________________________________
E-mail Address: _____________________________________________________________________
Magisterial District (Check one):
Cedar Creek _____ Warm Springs _____ Valley Springs _____ Williamsville _____ Millboro _____
I certify that I am a resident and qualified voter in Bath County, Virginia, and that I support the core principles of the Republican Party.
Signature: __________________________________________________________________________
Annual committee membership dues are $20 and are used for expenses. Please make your check payable to BCRC and submit it with this form. Thank you for your support and involvement.
Authorized by Bath County Republican Committee
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