Declaration of Candidacy for National Delegate from the State of Nebraska
If you need a printed copy mailed to you rather than filling out the form online, please email info@nebraskademocrats.org or call 402-434-2180.

DEADLINES FOR APPLICATION (MUST BE RECEIVED BY THIS TIME):
May 26, 2020 at 5:00 p.m. CT

Visit nebraskademocrats.org for the Nebraska Democratic Party’s Delegate Selection Plan.
Email address *
Phone *
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First Name *
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Last Name *
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Street Address *
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City *
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Zip Code *
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List the county (not country) you reside in: *
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Select the Congressional District you reside in: *
I certify that I am a qualified and registered voter of the county and Congressional District listed above where I reside. I further certify that I am a member of the Democratic Party, and understand that I must vote in the Democratic Presidential Primary Election to be eligible to be a Delegate/Alternate to the Democratic National Convention (aka “Convention”) to be held for the nomination of candidates for President and Vice-President of the United States. I further declare that, if selected as a Delegate, I will attend Convention unless I shall be prevented by sickness or other occurrence over which I have no control. I also understand that any expenses incurred to attend Convention (e.g. travel, airfare, hotel, etc.) are my responsibility. *
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I am declaring my candidacy for the following (check all the apply) *
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I hereby pledge my support to the Democratic Presidential candidate listed below. If elected as Delegate, I will cast my vote in good conscience to reflect the sentiments of those who elect me. These candidates were all listed on the Nebraska Primary Ballot, your choice can be different than who you voted for. *
The Nebraska Democratic Party is committed to having a diverse delegation that is representative of our state for the 2020 Democratic National Convention. Help us meet our diversity goals by checking any of the fields below that apply to you.
I identify as: *
Date of Birth *
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My checking the box below, I am giving my consent as an electronic signature for this submission. *
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Please note, pursuant to Rule 13.D of the 2020 DNC Delegate Selection Rules, the Presidential candidate(s), or their authorized representative(s), have right of refusal for all District-Level, At-Large, PLEO and Alternate delegate candidates. Pursuant to Rule 10.A.1 and Regulation 4.16 of the 2020 DNC Delegate Selection Rules, individuals shall be eligible for the pledged Party Leader and Elected Official (PLEO) delegate positions according to the following priority: big city mayors and state-wide elected officials (to be given equal consideration); state legislative leaders, state legislators, and other state, county and local elected officials and party leaders. *
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A copy of your responses will be emailed to the address you provided.
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