DELEGATE CANDIDATE RECRUITMENT FORM
Email
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First Name
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Last Name
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Address Registered to Vote From:
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City
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Employer
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Congressional District
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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:
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District Level Delegate
At-Large Delegate
Party Leader / Elected Official Delegate
Alternate
Gender:
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Male
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Age:
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17 to 36
36 to 64
65 and older
Ethnicity:
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Black or African Descent
Hispanic
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Asian American & Pacific Islander
White
Other
If other, please specify
Are you a Veteran of the U.S. Armed Services?
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No
Are you a person with a Disability?
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Yes
No
Do you consider yourself LGBTQ?
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Yes
No
Are you a member of a union?
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Yes
No
If yes, please specify the local:
Have you previously served as a delegate to the DNC?
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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:
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