Loudoun County Republican Committee Mass Meeting Filing Form

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.

名称(必须填写）
Address(必须填写）
(helpful)
(if known)
(if known)
(if known)
I hereby apply for (please check those that apply)(必须填写）

Please calculate the total for all your selections and submit your payment online here.

If you prefer to pay by mail, you may print the form here and send the completed form along with a check made out to the 10th Congressional District GOP.

10th District GOP
20098 Ashbrook Place, Suite 150
弗吉尼亚州阿什本 20147

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.
MM slash DD slash YYYY
Registration is not considered complete until payment is received.

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