Falls Church City Republican Committee
Membership and Delegate Form

Due in person by 7:30 PM, Thursday, March 7, 2016, at American Legion Post 130, 400 N. Oak Street, Falls Church VA 20046, or by mail to Alex Boston, Secretary, Falls Church City Republican Committee, to be received at Post Office Box 275, Falls Church VA 22046-0275  by 6:00 PM, Thursday, March 17, 2016 (postmarks do not count).


Name: ______________________________________________________________________________________

____________________________________________________________________________________________

Address:_____________________________________________________________________________________

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City/State/Zip:_________________________________________________________________________________

Telephone: _______________________________________________________                                                                     
Email:___________________________________________________________

Employer:___________________________________________________________________________________

Occupation:__________________________________________________________________________________

Location (City, State) of Employment  (e.g., Falls Church, Virginia):

______________________________________________________________________________________

Place ‘X’ in all applicable:

____Delegate, 8th District Convention (May 7, $20.00 fee which is transferred to the 8th District Committee)

____Delegate, State Convention (April 29-30, $35 fee which is transferred to the Republican Party of Virginia)

___Member, Falls Church City Republican Committee ($35 individual or $50 for a family at one address)

Amount : $____________    and name(s) of additional family members: ________________________________.

Names____________________________________________________________________________________


___Voluntary Processing Fee ($10)

___Additional Contribution $_______________________

Total contributions and fees: $______________________

Please pay by check or money order made payable to FCCRC.

Your signature:


____________________________________________________________


Please check the events in which you want to participate. Note that you must be a member of the Falls Church City Republican Committee to participate in the March 17 Mass Meeting, the 8thDistrict Convention and the State Convention.

____Falls Church City Republican Committee

The Committee is the official GOP committee for the City of Falls Church. The Committee works to elect Republicans, including determining how Republican candidates are nominated.


____8th District Convention
Become a Falls Church City Delegate or Alternate Delegate to the 8th District Convention on May 7, 2016  at Kenmore Elementary School in Arlington.

The District Convention elects a District GOP Chair, 3 members of the State Central Committee, 3 delegates and 3 alternate delegates to the National Convention, and a presidential elector.


____State Convention
The State Convention is April 29-30 at the James Madison University Convocation Center in Harrisonburg, Virginia.

The State Convention elects a State GOP Chair, a national committeeman and committeewoman, 13 delegates and 13 alternate delegates to the Republican National Convention, and two presidential electors.


Delegate Declaration

I, (name above), a duly qualified voter of the City of Falls Church, Commonwealth of Virginia, hereby declare that I am a candidate for delegate to the convention(s) checks above. I hereby certify that I am a qualified voter of the City of Falls Church, Virginia. I am in accord with the principles of the Republican Party and I intend to support the Republican nominees in the November 2016 General Election.

[Filing Fees are voluntary, but much appreciated]


Member Declaration

I, (name above), a duly qualified voter of City of Falls Church, Commonwealth of Virginia, hereby declare that I am a candidate for Member of the Fall Church City Republican Committee. I hereby certify that I am in accord with the principles of the Republican Party and I intend to support the Republican nominees in all elections during the two year term of the City Committee. I have remitted the mandatory members fee (above).


Contributions to the Falls Church City Republican Committee are not deductible as charitable contributions for Federal income tax purposes. Contributions meeting the requirements of Federal law may be used in connection with federal elections. Other contributions will be used only for non-federal elections.
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To comply with federal law, we must use best efforts to obtain, maintain and submit the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 per calendar year.
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Paid for and authorized by the Falls Church City Republican Committee, Post Office Box 275, Falls Church VA 22040-0275, and not by any candidate or political committee.