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Last Name: __________________________________ First Name: _____________________ MI: ____
Street Address: ____________________________ City: ________________ State: ____ ZIP: _______
Mailing Address: ___________________________ City: ________________ State: ____ ZIP: _______ (if different than street address)
County: __________________________________ Cell Phone: ________________________________
Email: ______________________________________________________________________________
Mail this completed application (include extra pages if necessary) and notarized Declaration of Candidacy to: Darryl Carlson
P.O. Box 116 Sheboygan, WI 53082
All forms must be received no later than February 28, 2020. Late submissions will not be considered.
Questions? Please email District Chairman Darryl at darryldcarlson@yahoo.com or call 920-627-2265.
1. Membership history in the party (local, state, national, auxiliary groups, contributor clubs, etc.) and the years you were a member.
2. List any offices and other leadership positions you held in the party of auxiliary groups listed above and the years you were in those positions.
3. List all county, district, state, and national committees, such as Rules, Resolutions, Credentials, Platform, Constitution, etc., you served on and the years.
4. List party activity committees you chaired or served on such as Lincoln Day Dinner, county fair booth, fundraisers, etc. and the years.
5. List all campaigns, by year, for public office that you worked for and what you did for those campaigns. (i.e. manager, coordinator, treasurer, volunteer, etc.)
6. List all political training sessions you have attended (i.e. state convention, Red to the Roots, NFRW campaign school, RNC Leadership Conference) and the years attended.
7. List any public offices held (local, county, state, or federal), personal candidacies, and/or any political appointments to government offices, boards, or commissions and the years.
8. List years you attended the Republican Party of Wisconsins Annual Convention.
9. Have you previously been a delegate or alternate to the Republican National Convention? If so, please list the year(s) of the RNC Convention.
10. List any other information you belive will help qualify you as a delegate to the RNC.
Endorsement (from County Party Chairman, Elected Official, etc.):
I know the applicant and find the application a fair representation of his/her activities and support him/her as a delegate applicant.
Name (please print): ______________________________
Signature: ______________________________________ Date: ______________________________
Declaration of Candidacy for National Delegate
By checking each box below you affirm and swear to each statement:
I am a current member of my county Republican Party and no later than the date of my county caucus for the county of ________________________ and will continue to be a member in good standing at the 6th District Caucus and through the Republican National Convention.
I am a qualified voter in the state of Wisconsin and have not committed a felony.
I will be required to pay all expenses connected with attending the 2020 Republican National Convention including air travel, hotel, meals, convention related expenses, delegate fee and all other possible costs. Estimated costs may run from $2,000 to $4,000.
I am available to attend the national convention in Charlotte, NC, on August 24-27, 2020 if nominated and elected at the 6th District Caucus, and give my word and pledge I will attend.
I will abide by the rules of the Republican Party of Wisconsin as stated in Article X of the RPW constitution and will support the presidental candidate who wins the election in the 6th District on April 7, 2020 until officially released by that candidate or until that candidate fails to receive at least one-third of the total votes cast in any vote for nomination at the Republican National Convention. If I fail to do so, I understand the Wisconsin caucus chair will immediately remove me as an unqualified delegate, appoint an alternate delegate in my place, and that person will cast my vote as prescribed by the rules the Republican Party of Wisconsin and the National Republican Committee.
I understand I may be required to sign a separate affidavit for the Republican Party of Wisconsin and will do so in a timely manner if required.
I understand I am subject to campaign vetting, including a background check, and this information will be shared with District Leadership.
I, ___________________________, being first duly sworn upon oath, depose and say: the above checked statements are accurate and truthful to the best of my knowledge, I am a qualified voter of the State of Wisconsin, I am a member of the Republican Party at my County Caucus, I am available and will definitely attend the National Republican Convention at my entire expense, and I will follow the rules of the Republican Party of Wisconsin and the laws of the State of Wisconsin.
____________________________________ Date: _______________ Signature of delegate candidate applicant
STATE OF WISCONSIN )
) ss.
County of _____________________,
Sworn to before me this __________ day of _________________________.
___________________________________________ Notary Public, State of Wisconsin
My commission expires ________________________.
[Type text] [Type text] [Type text]
PAGE 2
2020 Republican National Convention Delegate Application
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