Registration Form (Payment Already Completed)

Thank you for submitting your payment for Loudoun County Republican Committee and/or 10th District GOP participation.

Our records show that your payment was received, but the corresponding registration form did not come through in our system. We apologize for the inconvenience and appreciate your help completing the form below.

Please do not worry — your registration will be honored because your payment was received prior to the March 15, 2026 deadline at 5:00 PM. This form simply allows us to match your information with the payment already on file.

Please follow these instructions:

1. Complete the form for one person only.

2. If you purchased participation for multiple people, please submit one form for each individual.

3. You do not need to list what you purchased. We can see your payment and selections on our end.

4. Please ensure the name on the form matches the person who will be participating.

Once submitted, we will match the form with your existing payment in our records.

Thank you for your cooperation and for participating in the Loudoun County Republican Committee process.

The Code of Virgina Title 24.2, § 24.2-950.4 requires our political party committee to maintain a record of the name, address, occupation, name of employer or principal business, and employment location for each individual who contributes to our Committee. Completing the asterisked (*) fields satisfy these requirements. Your required information and membership contribution amount will be reported to the Virginia State Board of Elections.

Mass Meeting of the Loudoun County Republican Committee
March 21, 2026 at 10:00 a.m.
Fairfax Christian School
22870 Pacific Blvd, Sterling, VA 20166

10th District Convention of the Republican Party of Virginia
April 18, 2026 | 10:00 AM

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Last 4 SSN

(helpful)

Email(Required)

Telephone, Primary(Required)

Telephone, Secondary

Precinct

(if known)

Magisterial District

(if known)

Congressional District

(if known)

Occupation (or “retired”)(Required)

Employer (can be “self”)(Required)

City, State of Employment(Required)

Name of Person Who Submitted Payment(Required)

Signature

I, __________________________________, am a citizen of the United States, am a legal and qualified voter of Loudoun County under the laws of the Commonwealth of Virginia, regardless of race, religion, national origin or sex, who are in accord with the principles of the Republican Party, and express my intent to support all of its nominees for public office in the ensuing election.

Signature (type in name)

Date of Application