State Convention Delegate/Alternate Application for Consideration

2014 Texas Republican State Convention ~ June 5th – 7thin Fort Worth

Name: __Best Phone: ______

Address: City: Zip:

Precinct: Voter Certificate Number:

Occupation: Email:

How long have you lived in this county? _____

Have you donated to or volunteered for the local party in 2012 2013 2014

Did you attend your Precinct Convention? Yes No

The convention starts around noon on Thursday, June 5th, and ends late in the afternoon on Saturday, June 7th. Can you commit to attend the entire duration? If not, when will you be able to attend?______

I have voted in the following election(s):

2014 Republican Primary / 2010 General Election / 2008 Republican Primary
2012 General Election / 2010 Republican Primary / 2006 General Election
2012 Republican Primary / 2008 General Election / 2006 Republican Primary

I have been a delegate or alternate to the following Republican Party State Convention(s):

2012 State Convention / 2010 State Convention / 2008 State Convention / 2006 State Convention

During the past two years, I have for a Republican candidate(check all that apply):

Block walked / Worked at a phone bank Distributed campaign literature Assisted with mailings

List your past Republican party/campaign involvement (other than activities noted above).______

Please list all Republican/political groups you are involved with and titles as applicable.______

______

Why should you be selected as a delegate to the State Convention?______

2014 General Election Commitment (check all that apply):

I will support all Republicans appearing on the general election ballot. (If not, attach explanation.)

I will participate in door-to-door campaign block walks (August – October).

I will work ata phone bank (September –Election Day).

I will volunteer for the county Republican Party

I will volunteer in other ways, namely

I am particularly interested in helping the following candidate(s):

If I am not selected as a delegate, I would like to be considered for an alternate.YesNo

I understand that being a delegate/alternate to the State Convention is my financial responsibility. I am responsible for the cost of a hotel room, meals, and travel expenses.

SignatureDate

Please return your completed application to the county chair.