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    National Delegate Form

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    Official Account of the North Carolina Democratic Party
    This document is a notice of candidacy form for the 2012 Democratic National Convention. It allows the applicant to indicate that they intend to run as a delegate or alternate for the convention, and to pledge their support for a presidential candidate. The form requests contact information, demographic details, and a signature from the applicant. It provides deadlines of April 27, 2012 to run as a district delegate, and June 1, 2012 to run as an at-large delegate or party leader.

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    National Delegate Form

    Uploaded by

    Official Account of the North Carolina Democratic Party
    260 views1 page
    This document is a notice of candidacy form for the 2012 Democratic National Convention. It allows the applicant to indicate that they intend to run as a delegate or alternate for the convention, and to pledge their support for a presidential candidate. The form requests contact information, demographic details, and a signature from the applicant. It provides deadlines of April 27, 2012 to run as a district delegate, and June 1, 2012 to run as an at-large delegate or party leader.

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    This document is a notice of candidacy form for the 2012 Democratic National Convention. It allows the applicant to indicate that they intend to run as a delegate or alternate for the convention, and to pledge their support for a presidential candidate. The form requests contact information, demographic details, and a signature from the applicant. It provides deadlines of April 27, 2012 to run as a district delegate, and June 1, 2012 to run as an at-large delegate or party leader.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    260 views1 page

    National Delegate Form

    Uploaded by

    Official Account of the North Carolina Democratic Party
    This document is a notice of candidacy form for the 2012 Democratic National Convention. It allows the applicant to indicate that they intend to run as a delegate or alternate for the convention, and to pledge their support for a presidential candidate. The form requests contact information, demographic details, and a signature from the applicant. It provides deadlines of April 27, 2012 to run as a district delegate, and June 1, 2012 to run as an at-large delegate or party leader.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    PresidentialPreference

    2012DemocraticNationalConvention
    NoticeofCandidacy

    Iintendtoseekelectionasadelegateoralternatetothe2012
    Democratic National Convention to be held September 37,
    2012 in Charlotte, NC. I am a Democrat registered in the
    precinct,county,andcongressionaldistrictindicatedbelow.

    Iampledgedtosupportthefollowingpresidentialcandidate:

    ____________________________________________
    Uncommitted
    Intheeventmycandidacyisnotapprovedbythe
    presidentialcandidateofmychoice,Iwishtoruninthe
    uncommittedcategory

    Pleasecheckalloptionswhichapplytoyou:

    Iwishtorunfordelegateatthedistrictlevel(deadline
    tosubmit:4/27/2012at5pm)
    Iwishtorunforanatlargedelegate/alternateatthe
    stateconvention(deadlinetosubmit:6/1/2012at
    5pm)
    IwishtorunfordelegateataPartyLeader/Elected
    Official(deadlinetosubmit:6/1/2012at5pm).The
    party/electedoffice(s)Icurrentlyholdis/are:

    _____________________________________________

    _____________________________________________

    DemographicInformation
    (pleaseprint)

    Name:______________________________________________
    Address:____________________________________________
    City/Zip:_____________________________________________
    Precinct:_____________________________________________
    County:______________________________________________
    CongressionalDistrict:__________________________________
    Phones:
    Home:___________________________________________
    Office:___________________________________________
    Cell:_____________________________________________
    Fax:_____________________________________________
    EMail:______________________________________________

    Male
    Female

    Pleasecheckanythatapplyforaffirmativeaction
    purposes:

    AfricanAmerican
    NativeAmerican
    Hispanic/Latino
    AsianAmericanPacificIslander
    MemberoftheLGBTcommunity
    35yearsoryounger
    Personswithdisabilities
    Other:_______________________________

    Ialsopledge,ifelectedasadelegateofalternatetoattend
    themandatorymeetingoftheNorthCarolinaDelegation,to
    beheldimmediatelyfollowingtheadjournmentoftheState
    ConventiononJune16,2012

    Signature:___________________________________________

    Date:_______________________________________________

    NOTICEOFCANDIDACY

    Mustbereceivedbythefollowingdates:

    th
    April27 ,2012forcongressionaldistrictlevel
    June1st,2012forAtLargeDelegate/Alternate,orParty
    LeaderElectedOfficial
    PleasemailorfaxyourNoticeofCandidacyformto:
    DelegateSelectionOffice
    NorthCarolinaDemocraticParty
    220HillsboroughSt,Raleigh,NC27603
    FAX:(919)8214778 Phone:(919)8212777
    Formoreinformation,pleasecallthenumberaboveortollfree
    at(800)2293367,orvisitusatwww.ncdp.org

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