County Committee Members
Sign in to Google to save your progress. Learn more
Email *
County *
Name *
as it appears on Voter Registration
Voter Registration Number *
(SC 7-9-20 requires party members to be registered voters)
You can find yours at: https://vrems.scvotes.sc.gov/Voter/Login?PageMode=VoterInformation
Last 4 digits of Member's SSN 
Needed to verify voter registration, however not needed if member emails photo of his voter registration to secretary@sclp.org
Member's Birth Date
Needed to verify voter registration, however not needed if member emails photo of his voter registration to secretary@sclp.org
MM
/
DD
/
YYYY
Street Address *
City *
Zip Code *
Phone Number *
Text? *
Able to Receive Text at Phone Number?
State Delegate? *
County Officer? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of South Carolina Libertarian Party.

Does this form look suspicious? Report