Rockbridge Area Republican Committee (RARC)

Serving Rockbridge County, Buena Vista & Lexington

RARC Delegate Pre-File Form

Rockbridge County

I, __________________________________________________________, hereby
declare my intention to seek election as a Delegate from Rockbridge
County to the Republican Party of Virginias 2013 Convention. In
accordance with the Qualifications for Participation set forth in the
State Party Plan and the Call, I state that I am a registered voter
and that I do hereby state my intent to support all of the Nominees
of the Republican Party.
Signature: ____________________________________________ Date: ____________
Print Full Legal Name:
___________________________________________________________
Registered Voting Address:
______________________________________________________
City: ______________________________________________________, Virginia 24450
Home Phone: ______________________

Cell: ________________________

E-mail: _________________________________________________________________
Please make checks payable to the Republican Party of Virginia in
the amount of $35.00.*
*The $35.00 is a Voluntary Filing Fee to help to defray the cost of
the Convention.
Send this completed form and payment to Chairman Cher McCoy,
RARC, P. O. Box 1101, Lexington, VA 24450. This pre-file form must
be received no later than 4:00 p.m. on Friday, March 15, 2013.
Postmark will not govern.

Paid for and authorized by the Rockbridge Area Republican Committee