| Maricopa
County Republican Committee
|
| 3501
North 24th Street, Phoenix, AZ 85016
|
| (602)
957-3999 FAX (602) 553-8491 |
| Request for Precinct Committee
Appointment
|
| Congressional |
Supervisor |
Legislative |
|
Precinct |
| District___ |
District ____ |
District____ |
|
Name &
Number_______ |
Request is hereby made to the
Chairman of the (above) designated District and the Chairman of the Maricopa
County Republican Committee, that the following named Person be appointed to
the office indicated below:
PRECINCT COMMITTEEMAN
(P.C.)
| ______________________________________________
|
|
FULL
AND COMPLETE NAME AS REGISTERED TO VOTE. PLEASE, PRINT or TYPE.
|
|
________________________________________________________________
|
|
STREET/
CITY/ ZIP CODE
|
|
_______________________________________________________________
|
|
MAILING
ADDRESS, IF DIFFERENT
|
|
| (____)_______________ |
(____)_______________ |
_______________@____________ |
| HOME PHONE #
|
CELL PHONE #
|
EMAIL ADDRESS
|
| Date
of Birth ________________________________ Month/Day/Year____/______/_____ |
VID# _______________
|
|
Number of PC's authorized for Precinct _____
|
Number of
Vacancies___________
|
Verify that the individual is registered to vote at the above address
|
_______________________________ |
_____________________
|
|
Applicant’s Signature |
Date
|
|
_________________________________ |
_____________________
|
|
Precinct Captain’s Signature, if
applicable |
Date
|
|
________________________________ |
____________________
|
|
District Chairman’s Signature |
Date
|
|
Delivered to M.C.R.C. Headquarters |
_____________________
|
| |
Date
|
|