Pre-Registration

pre-register for the 2021 precinct caucus
BE A VOICE AND A VOTE FOR YOUR LOCAL PRECINCT!

WHEN: Saturday, March 20, 2021 (Check-In begins at 9:00 a.m.)
WHERE: Country Inn & Suites, 236 Old Epps Bridge Road, Athens 30606
NOTE: DOORS WILL BE CLOSED AND LOCKED AT 10:00 a.m. to convene the business of the convention.
(Forms will be accepted at the door, but pre-registration will expedite check-in.)
Additional convention information HERE.

PRE-REGISTRATION FORM

* Indicates required field

I am Pre-Registering for the Precinct Caucus Convention March 20 *

In person In abstentia by proxy

Precinct # or Name of Polling Location *

Congressional District *

Legal Name (First, Middle, Last) *

DOB (month / day / year) *

Address (Residence) *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Cell Phone *

Alternate Phone *

Mailing Address if different from residence *

MY PLEDGE AS A CONVENTION PARTICIPANT

I CERTIFY THAT I am a legally registered voter in Clarke County Georgia in the Precinct indicated above, and I desire to participate in the 2021 Clarke County Precinct Caucus. I further certify that I believe in the principles of the Republican Party. *

Yes No

I UNDERSTAND that in order to be elected as a Delegate or Alternate to the County Convention April 17, 2021, I must commit to attending the April 17 County Convention located at Country Inn & Suites, 236 Old Epps Bridge Road, Athens 30606, which will convene at 10:00 a.m. (DOORS WILL BE CLOSED SHARPLY AT 10:00 a.m.) *

Yes No

CLARKE COUNTY REPUBLICAN PARTY P. O. Box 1911 Athens, GA 30603

Date of submission (mo/day/year) *

Submit

pre-register for the 2021 precinct caucus
BE A VOICE AND A VOTE FOR YOUR LOCAL PRECINCT!