Membership Application - Sumter Republicans

Date(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Birth(Required)

How are your registered to vote?(Required)

Republican

Democrat

NPA

Nominating Member of the SCRP(Required)

All potential members must be nominated by a current member of the Sumter County Republican Party to be eligible to apply.

Dates of SCRP previously attended(Required)

Why do you want to become an REC member?(Required)

What contributions/skills can you contribute to further the goals and objectives of the REC?(Required)

Activities or events you would be interested in participating in(Required)

Headquarters Volunteer

Candidate Support

Get Out the Vote

Event Planning

Door to Door Canvasing

Fundraising

Other

If other:

Consent to Background Check(Required)

I agree

I hereby authorize the Sumter County Republican Party and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my request to join.

Digital Signature(Required)

I agree

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I confirm that all information provided in this document is true and accurate to the best of my knowledge. I further agree that my signature on this document is as valid as if I signed the document in writing.