FDP State Convention

Miami-Dade Democratic Party

Delegate Filing Form 2019
State Democratic Conference
Friday, October 11 - Sunday, October 13
Disney’s Coronado Springs Resort - Lake Buena Vista, FL 32830
Delegate Filing Requirements
For complete rules and filing requirements click here. To qualify as a delegate for the Miami-Dade Democratic Executive Committee you must be a registered Democrat in Miami-Dade County. Any registered Democrat may run to be a delegate. All candidates are required to fully complete this Delegate Filing Form by August 30, 2019.

Delegates will be selected at the next Miami-Dade Democratic Party meeting on Monday, September 9 at 7pm at [location TBA]. To reserve your spot as a delegate please pay the $60 registration fee online here.
STATEMENT OF CANDIDACY (filing deadline is Friday, August 30, 2019 at 5pm EST)
SECTION 1: Candidate Information
Name*

First NameMiddle NameLast Name
Nickname (if any):
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Home Ph:
Work Ph:
Mobile Ph:
DEC Member
Precinct (if you know it):
Are you an Elected Official, Public Office Holder or Party Leader? Please specify your title
Employer:*
Occupation:*
SECTION 2: Demographic Information
FMGender non-binary
LGBTSenior (65+)VeteranYouth (18-36)
African AmericanAsian/ Pacific AmericanCaucasianHispanicNative AmericanOther
If you have a Disability, please specify
If you are part of a Labor Union, please specify
If you are Native American, please specify tribe
I duly affirm and certify that I am a member of the Democratic Party of the United States; that I am a qualified elector of Miami-Dade County; that I will not support the election of the opponent of any Democratic nominee, nor will I support any non-Democrat against a Democrat in any election other than in judicial races; that I am qualified under the Constitution and Laws of the State of Florida and the Charter and Bylaws of the Florida Democratic Party to hold the position of delegate; that I have not violated any of the laws of the State of Florida relating to election or the Charter and Bylaws of the Florida Democratic Party.
I am committed to working actively for the election of Democratic candidates in the 2020 elections.
Signature*

Clear
Date
Should be Empty: