DELEGATE CANDIDATE RECRUITMENT FORM

Email*

First Name*

Last Name*

Address Registered to Vote From:*

City*

State*

Zip Code*

Mobile Phone

Occupation*

Employer*

Congressional District*

Link to Facebook Profile (if you have one):

Link to Twitter Profile (if you have one):

Link to Instagram Profile (if you have one):

I wish to be a candidate for:*

District Level Delegate
At-Large Delegate
Party Leader / Elected Official Delegate
Alternate

Gender:*

Male
Female
Non-binary

Age:*

17 to 36
36 to 64
65 and older

Ethnicity:*

Black or African Descent
Hispanic
Native American
Asian American & Pacific Islander
White
Other

If other, please specify

Are you a Veteran of the U.S. Armed Services?*

Yes
No

Are you a person with a Disability?*

Yes
No

Do you consider yourself LGBTQ?*

Yes
No

Are you a member of a union?*

Yes
No

If yes, please specify the local:

Have you previously served as a delegate to the DNC?*

Yes
No

[if yes] Please specify the year, and the candidate you were a delegate for:

Did someone refer you to this form? Please let us know who:

By signing my name, I certify that I am a registered Democrat; I am committed to the candidacy of Vice President Joseph R. Biden; and that, if I am chosen as a delegate, I pledge my support to the nomination of Vice President Biden as the nominee for President of the Democratic Party at the Democratic National Convention and at any state or local party proceedings preceding the Convention.

Digital Signature:*

Please leave this field blank:

* denotes required field

By signing my name is certify that I am a registered Democrat and commit to support Vice President Biden for President through the convention.

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