Cash Donation Form Donation Amount Merchandise First Name Last Name Email address Street Address City State ZIP Country United States Employer Leave this field empty if you're human: CONTACT INFO First Name* Last Name* Date of Birth* Email address* Phone Number* Street Address* City* State* ZIP* Country* Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Precinct # Voter ID #* History and Experience Years as a Registered Republican?* Years Registered in St. Lucie County?* Current Employment and Occupation* List any past precinct experience or work for the Republican Party* Other Affiliations? Ever Convicted of Felony?* Special Interest (Choose Top 3) 1st Choice Auditing and Budget Fundraising events for the Executive Committee Get Out the Vote Program Hospitality Headquarters Administrative Volunteer Legislation Marketing/Public Relations Membership Newsletter Telephone Banks Photography Poll Watcher Voter Registration Election Integrity 2nd Choice Auditing and Budget Fundraising events for the Executive Committee Get Out the Vote Program Hospitality Headquarters Administrative Volunteer Legislation Marketing/Public Relations Membership Newsletter Telephone Banks Photography Poll Watcher Voter Registration Election Integrity 3rd Choice Auditing and Budget Fundraising events for the Executive Committee Get Out the Vote Program Hospitality Headquarters Administrative Volunteer Legislation Marketing/Public Relations Membership Newsletter Telephone Banks Photography Poll Watcher Voter Registration Election Integrity Sign and Date Today's Date* Referred By: Signature* Required * Leave this field empty if you're human: