Test Site
Donate to Scholarship Fund
Membership Application
*
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip Code
*
Mobile Phone
*
Home Phone
*
Email Address
*
Birthday
Voter Registration Number
If not Retired, Please fill out Organization Name and Occupation.
Retired
Employer
Occupation
Volunteer Interests
Greeter at Meeting
Lead Invocation
Computer Work
Walk Neighborhoods
Lead Pledge
Fundraising
Mailings
Sing Anthem
Special Event
Telephone Calling
Other
Military Service
Self
Spouse
Active
Retired
Veteran
Other
Branch
Rank
*
Membership Level (click menu, arrow on right, to change)
Veteran Membership ($30)
New Regular Membership ($50)
New Associate Membership ($50)
Membership Renewal ($45)
Associate Membership Renewal ($45)
Stilettos Membership ($150)
Pearl Membership ($250)
Diamond Membership ($500)
MAGA Membership ($1,000)
Cost:
$50.00
Thank you!
Payment Complete
Submit Application
Phone:321-727-1212
Contact:PO Box 410143,
Melbourne FL 32941-0143
BFRW.USA@gmail.com
Copyright @ 2025 Brevard Federated Republican Women
