Delegate Candidate Registration « « The 99% Declaration Delegate Candidates The 99% Declaration Delegate Candidates

# Delegate Candidate Registration

Thank you for your interest in participating in the 99% Declaration election of Delegate Candidates!
Complete the form below to register and add your public profile. More details about the election are on the website.

- UserName*
  No spaces please.
- Email*
  Enter Email Confirm Email
- Password*
  Enter Password Confirm Password
  Strength indicator
- Name*
  First Last
- Address*
- City*
- State*
- Zip+4 Code*
  Click here to look up your Zip+4 Code.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Maryland*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District*
  Your state has multiple congressional districts. Find yours by visiting
  www.house.gov and entering your zip code in the search in the upper right.
- Congressional District *
- Gender*
  For each Congressional District, one male and one female will be elected. Delegates who do not identify as either male or female may choose to run for either the male or female delegate seat but not both.
- Voter Eligibility*
  - I certify that I will be at least 18 years old by March 23, 2012 and that I am eligible to vote in the U.S. in my Congressional District as indicated above.
- Delegate Eligibility*
  - I certify that I meet the Requirements for Becoming a Delegate.
- Violent Felony?*
  This requirement pertains to our group being able to get insurance as required by the venue for the event in Philadelphia the week of July 4, 2012. It pertains only to VIOLENT felonies.
  - I have not been convicted of a violent felony in the past 10 years.
- Captcha
  Use the controls to the right of the captcha image if you are having trouble reading the image. You can load a new image with the top icon or have the image letters spoken aloud by clicking on the speaker icon.

Close
PreviousNext
PreviousMaximize
Next