Application Form

Please print this page and after entering required information, mail or fax to:

Republicans Abroad Japan

E-mail: rajapan@gol.com

Membership Application

_____ I am a U.S. citizen and wish to join Republicans Abroad Japan (RAJ); I understand that
RAJ dues are JPY 5,000 per person per year.

_____ I am NOT a U.S. citizen, but wish to join Friends of Republicans Abroad Japan (FRAJ);
I understand that FRAJ dues are JPY 5,000 per person per year and will be used only in
Japan to support RAJ.

Annual membership may be paid by bank transfer to the account of Republicans Abroad Japan,
Citibank N.A., Hiroo Branch, Yen Savings Account No. 5811066; or by registered mail to
Republicans Abroad Japan at the address shown above. Sorry, no credit cards accepted.

Name: ____________________________________________________________________

Home address: ____________________________________________________________

City/Postal code: __________________________________________________________

Home phone: ___________________________ Home Fax: ______________________

Work phone: : __________________________ Work Fax: _______________________

E-mail address: ________________________________________ (Home / Office)

Nationality: ____________________________________

If US citizen, last U.S. residence:

City: _______________________ State: ______ County:___________________

Signature: _______________________________________ Date: ________________

I would like to participate/assist in the following activities:

_____ Voter registration _____ Programs/Special events _____ Membership

_____ Communications/Publicity _____ Fundraising _____ Young Republicans

_____ Other (please specify) _______________________________________________