2021 State Convention Delegate Filing Form

Please complete all fields

Note: Voter Number and Name must be as it appears on your voter registration. To find your voter number and registered name check your voter card or visit: https://vote.elections.virginia.gov/VoterInformation and click "check registration status"

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*YOU MUST BE A RESIDENT OF THE CITY OF LYNCHBURG TO FILE THIS FORM*

By clicking "Submit" I further certify that all of the information contained in this form is true and accurate, that I am the individual named in this form and that my certification shall serve as a digital signature made by my hand. 

The deadline to submit this form is 8:00 PM EDT on Monday, April 19, 2021

Lynchburg Republican City Committee

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Lynchburg Republican Party
P.O. Box 12237
Lynchburg, VA 24506

© 2021 Lynchburg Republican City Committee