39th LD Caucus Delegate Registration Form
The below form is to register to run to be delegate at the upcoming Legislative District Caucus for LD  39

Please provide all information as completely as you can, as this information will be required to attend the Convention in June.

Please reach out to jordansears.democrat@gmail.com If you have any questions

If you are unsure about which LD you are in, you can check here: https://leg-tech.maps.arcgis.com/apps/webappviewer/index.html?id=3413cce928744f6a86bd631d97e2a06a
Email *
Your email *
Please put in your email
Phone number
Full name *
Full address *
Please provide the address you are registered to vote at, or that you reside at, if you are unregistered to vote.
Gender Identity *
Delegate selection rules require that delegations be divided equally between male and female individuals. Those individuals who do not identify binarily as either Male or Female should select "Gender Non-Binary". These individuals do not count in the split between Males and Females. For instance, a Legislative District may have 5 males and 4 females, or 3 males, 4 females, and 2 gender non-binary individuals, as the difference between males and females is not more than 1, but may not have 2 males, 4 females, and 2 gender non-binary individuals, as the difference between males and females is 2.
If elected will you be attending the June Convention Virtually or In-Person? *
If you would like to provide a statement for your election to delegate please provide it here and it will be distributed to voting members no later than 3/24/2022
Please identify which of the following categories you identify as for the purposes identifying our districts success with the delegate selection plan's Affirmative Action goals *
Required
A copy of your responses will be emailed to the address you provided.
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