Congressional District where you live and are registered to vote: *
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Complete home Street Address, City, ZIP *
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Home Phone *
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Mobile Phone *
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Email address *
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By declaring your preferred presidential candidate, you are agreeing to vote in the election of delegates to support that particular candidate and only that candidate. PREFERRED PRESIDENTIAL CANDIDATE: *
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Type your INITIALS here to signify and proclaim that the following statement is true: I believe in the goals of the Democratic Party of Georgia. *
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Type your INITIALS here to signify and proclaim that the following statement is true: I am not a member of any other political party or body as defined in the Georgia Election Code. *
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Please TYPE YOUR NAME and DATE here as signature to this form. *
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