2024 3CD RNC Delegate Nomination Form

3rd District GOP RNC Delegate Nomination Form

Forms must be received by April 13th, 2024
Personal Information
Full Name as it appears on the NC Voter Rolls:*

First NameMiddle NameLast NameSuffix
Preferred Name, if different from full name:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Date of Birth*

MonthDayYear
U.S. Citizen?*

YesNo
N.C. Resident?*

YesNo
County*
Congressional District*
Questions and Details
I am currently a: (select all that apply)*

VolunteerMember of any other Republican OrganizationCounty Party OfficerDistrict Party OfficerState Party OfficerOther (please describe below)
If other was selected, please describe:
During the past 2 years, I have: (select all that apply)*

Knocked on doors for a Republican nominee for the General Election.Distributed campaign materials supporting a Republican nominee in the General Election.Assisted with campaign mailings to help a Republican nominee for the General Election.Made phone calls for a Republican nominee for the General Election.Volunteered with my County Party.Volunteered with my Congressional District Party.Volunteered with the State Party.Attended my Precinct Meeting.Attended my County Convention.Attended my District Convention.Attended the State Convention.Other (please describe below).
If other was selected, please describe:
Please list your previous campaign involvement. If you do not have any, please enter "none."*
Why do you want to serve as a Delegate to the 2024 Republican National Convention?*
Please provide links to any social media accounts you have.

If you do not have any, please enter N/A.
Facebook*
Instagram*
X (formerly Twitter)*
YouTube*
Other*
Other*
If you are not elected as a Delegate would you still like to be considered as an Alternate Delegate or Replacement Alternate?*

YesNo
Serving as a Delegate or Alternate Delegate is a large financial responsibility. By submitting you are confirming that you are willing and able to cover the cost of hotel, travel, and other expenses. Furthermore, you understand that these costs may exceed $2,500 per person.
2024 National Convention Delegate Pledge

If selected as a Delegate or Alternate Delegate to the 2024 Republican National Convention, I agree to abide by all NCGOP and RNC Rules.

"The Delegates and Alternate Delegates serving as Delegates to the National Conventions shall be bound by the results of the Presidential preference primary for the first two (2) ballots and shall vote for the candidate to whom they are pledged. Should more than two ballots be required, the Delegates and Alternate Delegates serving as Delegates shall no longer be bound to the result of the Presidential preference primary; however, the Delegates and Alternate Delegates serving as Delegates shall be bound by the will of the North Carolina Delegation to the National Convention, who shall meet and determine how the North Carolina Delegation shall vote. Only Delegates and Alternate Delegates serving as Delegates shall be permitted to vote during the meetings of the North Carolina Delegation at the National Convention."

I attest that I am a registered Republican in the state of North Carolina and further attest that I am eligible to vote in North Carolina elections. I consent to have a background check run upon submission of my application to the NCGOP. I further declare that if selected as a Delegate or Alternate Delegate to teh 2024 Republican National Convention, I will attend the convention unless prevented by sickenss or other occurence over which I have no control.
I have read the above and understand that as a Delegate or Alternate Delegate, I will be bound to represent the candidate I was selected to represent.
Date*

MonthDayYear
Date
Should be Empty:

3rd District GOP RNC Delegate Nomination Form

Personal Information

Questions and Details

Please provide links to any social media accounts you have.