**Please Note: This form is to run for the following positions:
National Pledged Party Leader and Elected Official (13 elected at the June 22 State Convention)
At-Large National Delegate (21 Elected at the June 22 State Convention)
At-Large National Alternate (2 Elected at the June 22 State Convention)
District Level National Delegate (Elected at Congressional District Conventions)
District Level National Alternate (Elected at Congressional District Conventions)

These positions go to the National Convention in Chicago

You can file this form online at www.vademocrats.org/delegateselection.

I, the undersigned, certify that I am a Democrat, am a registered voter in __________________,
subscribe to the principles of the Democratic Party, do not intend to support any candidate
who is opposed to a Democratic Nominee in the next ensuing election, and will not participate in the nominating process of any other political party.