Polk GOP - Membership Application

POLK COUNTY REPUBLICAN EXECUTIVE COMMITTEE MEMBERSHIP APPLICATION
Your Name (as it appears on your Voter Registration)

PrefixFirst NameMiddle NameLast NameSuffix
Preferred Name
Can be a nickname, initials, etc.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Polk County Precinct Number
Follow this link to find your precinct
Florida Voter Identification Number
Follow this link to find your Voter ID
Prior Republican Volunteer/ Professional Experience:
Are you a prior member of Polk GOP or any other REC?
If Yes, please add details
As an Polk GOP member, are you interested in working with:
IMPORTANT: To be eligible you must attend an Polk GOP general meeting prior to being listed on a membership ballot. You must sign the FLORIDA REPUBLICAN PARTY LOYALTY OATH and a state mandated CANDIDATE OATH. Polk GOP will request a copy of your VOTER AUDIT REPORT from the Supervisor of Elections to verify your eligibility. You can attend an optional Polk GOP New Member Class.
Signature
Today's Date

MonthDayYear
Date
Paid for by the Polk County Republican Executive Committee of Florida and not authorized by any candidate or candidate's committee.
Should be Empty:

POLK COUNTY REPUBLICAN EXECUTIVE COMMITTEE MEMBERSHIP APPLICATION