Authorized and Paid for by

The Chesterfield County Democratic Committee

7617 Pocoshock Way

North Chesterfield, VA 23235

©  Chesterfield County Democratic Committee

2020-21 Declaration of Candidacy for Membership to the Chesterfield County Democratic Committee

By completing this form, I hereby declare myself to be a candidate for membership on the Chesterfield County Democratic Committee. I also declare that I believe in the principles of the Democratic Party and that I will not support any candidate opposed to any candidate nominated or supported by the Democratic Party as long as I am a member of the Committee.

I am registered to vote in Chesterfield County in the following Precinct and Magisterial District:

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I am NOT registered to vote in Chesterfield County and I am applying as an Associate Member of CCDC, which is a non-voting position.

I reside in the following locality:

The following information is required by the Campaign Financial Report provisions of Virginia Law as any payments made by you to CCDC, including dues, are reported to the State Board of Elections.

DUES:

$30.00 for 1 year

$50.00 for 2 years

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