2025 Membership Application

Membership Application may be submitted by the FILLABLE FORM BELOW, or you may download and mail a hard copy here.

Join Us

Your Name:

Your Name:

First Name

Middle Name

Last Name

Spouse's Name (if applicable):

Spouse's Name (if applicable):

Spouse's First Name

Spouse's Middle Name

Spouse's Last Name

Spouse's Suffix

Physical Address:

Physical Address:

Street Address

Town / City

State

ZIP Code

TOWNSHIP

Mailing Address:

Mailing Address:

Street Address / PO Box

Town / City

State

ZIP Code

Contact Info:

Contact Info:

Landline Phone

Cell Phone

Do You Text?

2nd Email (Spouse's)

Are You on Facebook?

Best method to reach you?

Occupation Information Required:

OCCUPATION information is REQUIRED by the State of Michigan.

OCCUPATION

busname if Self Employed

Self-Employed - Please provide name of business:

Business Name

Business Address

Elected Officials & Yearly Dues:

Elected Officials & Yearly Dues:

"elected official"

Effective January, 2018, any Republican “Elected Official” in Leelanau County must be, or have been, a dues paying member of the LCRP each year the individual was an “Elected Official” in Leelanau County for the LCRP to endorse and support the individual in an election.

Select Memberships:

Select Memberships:

Memberships options

Lifetime Member - $1,000

Chairman's Council - $500

Sustaining Member - $250

Contributing Member - $100

Family (2 adults / 2 children) - $50

Individual Member - $25

Student (not included in Family Membership) - $10

TOTAL DUES to be paid:

TOTAL DUES to be paid:

[TOTAL DUES to be paid:]

*if using check*

*if using check please include*

Check #

Check Amount

Payment Options

Payment Options:

Pay Online - fill out and submit the above online form and pay using the Membership Payment button below.

Check - Please make personal check payable to: L.C.R.P. (Cash or business checks cannot be accepted.) Mail to: LCRP c/o Linda Shimek 12161 S. Coleman Road, Empire, MI 49630 or bring to the next meeting.

Membership is due 1/31.

*Sometimes the online payment feature or other computer connection acts up. Please don't get discouraged. You may simply use the traditional nostalgic way to pay, mailing or delivering your check.

Pay 2025 Membership Online

Thank you for joining the team!

2025 Membership Application

Join Us

12161 S. Coleman Road,

Empire, MI 49630

info@leelanaugop.org

Paid for with regulated funds by Leelanau County Republican Committee.

Not authorized by any candidate committee.

12161 S. Coleman Rd., Empire MI 49630

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