Central Committee Alternate Designation Form
This form is for 2021-2022 Central Committee members only. Please do not share.

Alternates must be registered Democrats who live within the same Assembly district as their Central Committee member. Alternates who have not paid dues by the first meeting in January will not have voting privileges.
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What is your name? *
What is the FIRST name of your designated Central Committee Alternate? Please use their voter registration name. *
What is the LAST name of your designated Central Committee Alternate? Please use their voter registration name. *
If there a nickname that your designated Central Committee Alternate goes by, please list here:
What is your Alternate's best mobile phone number? *
What is your Alternate's best email? *
What is their best home phone number?
What is their best work phone number?
What is the street address of the designated Central Committee alternate? Please use the address of voter registration. *
What city is the designated Central Committee alternate in? *
What zip code is the designated Central Committee alternate in? *
What gender identity is the designated Alternate? *
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