CANDIDATE PROFILE FOR MEMBERSHIP IN THE
BENTON COUNTY REPUBLICAN ASSEMBLY

NAME______________________________________________________________________

ADDRESS in Benton Co._______________________________________________________
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HOME PHONE:____________________ BUSINESS PHONE:__________________________
FAX:_____________________________ CELL PHONE:______________________________
EMAIL ADDRESS __________________________________________________________

OCCUPATION______________________________
SPOUSE* ________________________________
*SPOUSES MUST COMPLETE THEIR OWN PROFILE TO JOIN

BACKGROUND GOP INFO

MEMBER OF_______________________COUNTY REPUBLICAN COMMITTEE

COUNTY, DISTRICT OR STATE RPA OFFICES PREVIOUSLY HELD
OR NOW HOLD (ELECTED OR APPOINTED):
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PUBLIC ELECTED OFFICE(S) PREVIOUSLY HELD OR NOW HOLD (DATES)
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AREAS OF GREATEST POLITICAL INTEREST/CONCERN (BE SPECIFIC)
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I HEREBY AFFIRM MY CONCURRENCE WITH THE BCRA, ARRA and NFRA BELIEFS,
PRINCIPLES AND OBJECTIVES.
SIGNED________________________________________________DATE_________________

BENTON CO. REPUBLICAN ASSEMBLY (SPONSOR) _______________________________________

DUES: $20 / year ($10 goes to your ARRA and NFRA membership)