KRAA.ORG Membership Form

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Name:

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Spouse/Other family member who wishes to join

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Address

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City                                                             St.                 Zip

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Home Phone

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Business or other phone

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Email address

I understand that in order to become and remain a member of KRAA.ORG, I must be a

Republican, uphold the principles and purposes of the KRAA.ORG and keep my dues

current.

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Signature of Applicant

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Signature of Spouse if joint membership

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Date

Annual Dues

Regular Membership                            $25.00

Spouse or other family member            00.00

Total                                                         ______

Mail application and dues to

KRAA.ORG

C/O Mark S. Gietzen
5575 South Mosley Street
Wichita, Kansas 67216-3631