Apply to Become a Precinct Chair Please enable JavaScript in your browser to complete this form.Precinct # *Must live in and be registered to vote in this voting precinct.Name on Voter Rolls: *FirstMiddleLastAs it appears on your voter registration card.Pronouns *He/himHe/himShe/herThey/themI prefer not to share themOther (please tell us what you would like)Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Preferred Name for Website: *Voting Address: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address (if different):Address Line 1Address Line 2CityTexasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone:Permission to text: YesNoHome Phone:Work Phone:Please indicate which is your preferred phone: *CellHomeEmail: *EmailConfirm Email(Will be used for internal communication only and will not be published. Please do not use a work or school email address.)Occupation *Required by Federal and State law for campaign finance reporting purposes.Employer: *Must not be a candidate for, nor holder of, an elective office of the federal, state, or county government. [Texas Election Code Sec. 161.005(a)(2)]Precinct Chair Applicants, Please Initial (2-3 characters, uppercase):I agree that I will provide at least one method for constituents to contact me, to be published on the CCDP website. I agree that in order to fulfill my duties as a Precinct Chair that the CCDP may contact me via phone, text, and/or email. *I understand this commitment can be up to two years, depending on the time left in the term, which expires in June of even-numbered years, and this is a statutory, unpaid position. *I understand I need to attend (statutory and other) County Executive Committee Meetings as scheduled (at least quarterly, could be monthly) and that I may be considered to have abandoned this office if I miss three consecutive meetings in a two-year term. *Oath of Affiliation: “I swear that I have not voted in a primary election or participated in a convention of another party during this voting year. I hereby affiliate myself with the Democratic Party." *Signature (name): *Date: *PhoneSubmit