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.
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?*

YesNo
If Yes, please add details
As an Polk GOP member, are you interested in working with:

Polk GOP HQ Office VolunteerVolunteer Poll WatcherPaid Election Poll Worker w/ Supervisor of Elections OfficePhone Call TeamText TeamReaching out to my neighbors/precinctDoor Knocking - WalkerDoor Knocking - DriverNotes for VotesSign Distribution TeamVoter Guide Distribution at PollsText the voters/contacts in my phoneEvents Team
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*

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Today's Date*

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Date
Paid for by the Polk County Republican Executive Committee of Florida and not authorized by any candidate or candidate's committee.
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POLK COUNTY REPUBLICAN EXECUTIVE COMMITTEE MEMBERSHIP APPLICATION