REPUBLICAN PRECINCT COMMITTEEPERSON APPOINTMENT REQUEST FORM 

Please check one:                                                                                                   

I would like to be appointed as a Precinct Committeeman                             

 

I would like to be appointed as a Precinct Committeewoman                        

 If there is no vacancy in my resident Precinct, please appoint me in an adjacent precinct. 

                                                                                                                                     

Name:                                                                                                                          

 

Street Address:                                                                                                                  

 

City, State, ZIP:                                                           County:                                

 

Phone:                                                      Fax:                                                          

 

Email:                                                                                                                          

 

Precinct Name or Number:                                                        

 I certify that I have been a registered Republican for at least 180 days.

 

 

Signature:                                                                             Date: