2017 State Convention Form

Delegate Filing Form 2017
State Democratic Conference
Friday, October 27 - Sunday, October 29
Disney’s Coronado Springs Resort - Orlando, FL 32830

Delegate Filing Requirements
To qualify as a Miami-Dade delegate you must be a registered Democrat in Miami-Dade County. All candidates are required to file this Delegate Filing Form by Wednesday, October 11, 2017 at 11:59 pm. Delegates will be selected at a special Miami-Dade Democratic Party general meeting on Thursday, October 12 at 7 pm at the South Florida AFL-CIO located at 4349 NW 36th St, Miami Springs, FL 33166. To reserve your spot as a delegate please pay the non-refundable $60 registration fee online here. If you have any questions, please contact Carlos Condarco at carlos@miamidadedems.org

STATEMENT OF CANDIDACY (filing deadline is Wednesday, October 11, 2017, at 11:59 pm EDT)

SECTION 1: Candidate Information

(Please input name as it appears on your Voter ID card)

First Name:*

Last Name:*

MI:

Address:*

City:*

Zip:*

E-mail:*

Home Ph:

Work Ph:

Mobile Ph:

Miami-Dade DEC Member?

YesNo

Precinct (if you know it):

Are you an Elected Official, Public Office Holder or Party Leader? If so, please specify your title.

Employer:*

Occupation:*

SECTION 2: Demographic Information

Gender:*

FMOther

Race/ Ethnicity*

Diversity

LGBTSenior(65 & up)VeteranYouth (18 -36)

If you have a Disability, please specify

If you are part of a Labor Union, please specify

Loyalty Oath:*

I duly affirm and certify that I am a member of the Democratic Party of the United States; that I am a qualified elector of Miami-Dade County; that I will not support the election of the opponent of any Democratic nominee, nor will I support any non-Democrat against a Democrat in any election other than in judicial races; that I am qualified under the Constitution and Laws of the State of Florida and the Charter and Bylaws of the Florida Democratic Party to hold the position of delegate; that I have not violated any of the laws of the State of Florida relating to election or the Charter and Bylaws of the Florida Democratic Party.

I am committed to working actively for the election of Democratic candidates in the 2018 elections.

Sign:

Date:

Date