Filing Form for Officer Elections

 

Please complete the form below to submit yourself for nomination for the election of officers of the Caucus and PAC of LGBT Democrats of Virginia. The deadline for submission is May 15, 2012 for Caucus candidates, and May 20, 2012, for PAC candidates. You must be a current member of the LGBT Caucus to be nominated in this election. Information submitted via this form will be sent to the Nominating Committee, who will publish a ballot of candidates on June 1st, 2012.

*I'm Filing for the Office of: 

*Full Name: 

*Address:     

*City:                                                *Zip: 

If your mailing address is different than the address above, please also include your mailing address below:

Mailing Address:  

City:                                                   Zip: 

Additional contact information.

*Home Phone:                                   Work Phone: 

 Mobile Phone:    

*Email Address: 

*Congressional District:                                     *City/County: 

Your information to be sent to members who will be voting.

*Upload Photo of Yourself. This photo will be posted to the website and emailed to members for the purpose of this election. Please crop your picture to 150 pixels by 150 pixels. Your image will be cropped if submitted larger.

*Your Profile. Please let us know who you are and why you're seeking election. This information will be posted to the website and emailed to members for the purpose of this election Please keep your submission to 300 words or less.

By submitting this form, you agree that your nomination will only be made if you meet the requirements of being a candidate as prescribed by the bylaws of the LGBT Caucus of the Democratic Party of Virginia.

 

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