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* 1. Name

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* 2. Address

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* 4. NWJCR is a citizen-organized group of grassroots conservative Republicans dedicated to electing candidates who will promote the time-honored principles of limited government, fiscal responsibility, low taxes, traditional values, respect for life, law and order, clean government, personal responsibility, a strong national defense and patriotism.

Do you pledge to help us support this mission?

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* 5. Let us know the following ways you'd like to be involved - check all that apply.

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