Membership Application

The information we gather in this form will only be shared with other Federation members and used in the application process.

* Denotes Required Fields

*Group Name

*Type of Group (Tea Party, 912, Patriot, Other):

*Doing Business As(tea party x,y or z):

*Mailing Address (Include City and ZIP):

*County

*Key or Lead Person:

*Email:

*Phone Number

*Website

*Other Site Address (Facebook, Ning, Twitter, etc):

*Business Structure:

If "other" was selected from above:

*Leadership Structure:

If "other" was selected from above:

*Number of Active Members:

*Size of Mailing List(number of people you reach):

*Can you commit to participating in at least one conference call per month & 2/3 of bi-monthly meetings (4 of 6 per year)?
 Yes No

*Brief History (when started):

*Number and Types of Activities and Number of Attendees:
Rallies, Protests, Educational Seminars, Workshops, Outreach,
Election Related

*How Often Do You Meet (bi-weekly, monthly, quarterly)?
 bi-weekly monthly quarterly

Fundraising ideas that have worked for your TP:

*Vision and Goals of your TP:

How will you grow your Tea Party?:

*Existing relationships your TP has with other groups (please indicate if your proposed leadership contact with the Federation is an officer in a political party or partisan group):

*Skill set specializations in your TP (e.g. lawyer, internet guru, database guru, mailhouse, insurance salesman):

*What Congressional District's does your Tea Party represent?

*What VA House Of Delegates District's does your Tea Party represent?

*What VA Senate District's does your Tea Party represent?

Any Additional Information that you would like to provide: