Late-Filing Delegate Interest Form
Please Note: This form is an application to fill the delegate vacancies in the Virginia State Democratic Convention delegation. This form does not ensure you a place in the delegation at your Congressional District Conventions or State Convention.
Sign in to Google to save your progress. Learn more
I, the undersigned, certify that I am a Democrat, am a registered voter in the locality I indicate below, subscribe to the principles of the Democratic Party, do not intend to support any candidate who is opposed to a Democratic Nominee in the next ensuing election, and will not participate in the nominating process of any other political party. *
Full Name *
Address Line 1 *
Address Line 2
City *
ZIP Code *
Phone Number *
Email Address *
Congressional District *
Locality *
Presidential Candidate Preference *
Gender Identity *
Optional Demographic Information (check all that apply)
Opt-Out
If you check this box, we will not share your contact information with the candidates for National Delegate, Elector, or DNC Member. 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Democratic Party of Virginia. Report Abuse
Google Forms