Kansas Democratic Party PO Box 1914 | Topeka, KS 66601 | 785.234.0425 www.KansasDems.org
Declaration of Candidacy for Delegate “I, ______(print name), of ______, Kansas, hereby declare my candidacy for (please check one below):
_____ District-Level Delegate _____ At-Large Delegate _____ Pledged Party Leader and Elected Official (PLEO) Delegate *****Separate forms must be submitted for each category you wish to apply for.
“I certify that I am a qualified and registered voter in ______county in the State of Kansas and the ______Congressional District.”
“I further certify that I am a member of the Democratic Party, and I understand that I must be elected at the District Convention as a Delegate or be elected at the State Convention as a Delegate or Alternate to be eligible to be a Delegate to the Democratic National Convention (aka “Convention”) to be held for the nomination of candidates for President and Vice-President of the United States.”
“I further declare that, if selected as a Delegate, I will attend the Convention unless I shall be prevented by sickness or other occurrence over which I have no control. I also understand that any expenses incurred to attend the Convention (e.g. travel, airfare, hotel, etc.) are my responsibility.”
Pledge of Support
“I hereby pledge my support for ______, candidate for President of the United States, and, if elected as a Delegate, will cast my vote in good conscience to reflect the sentiments of those who elect me.”
Signature: ______Date: ______
Contact Information (Must be completed for consideration): Name: ______Congressional District: ______Street Address: ______Senate District: ______City: ______Email: ______State: ______Phone: ______Zip: ______Date of Birth: ______FORM MUST BE MAILED OR EMAILED TO: DEADLINES FOR APPLICATION: KDP c/o Delegate Selection Plan District- Level Delegates: May 15, 2020 by 5:00 PM PO Box 1914, Topeka, KS, 66601 At-Large Delegates: May 22, 2020 by 5:00 PM [email protected] PLEO Delegates: May 22, 2020 by 5:00 PM
Paid for by the Kansas Democratic Party, Gina Long, Treasurer. Optional Self- Identification Questionnaire
The Kansas Democratic Party is committed to having a diverse delegation that is representative of our state for the 2020 Democratic National Convention.
Help us meet our diversity goals by circling any of the fields below that apply to you:
African American Latino Native American
Youth (ages 18-34) Asian or Pacific Islander Senior
LGBT Person with Disability Rural
Labor
Ethnicity: ______
Tribal Affiliation: ______
Labor Union Affiliation: ______
Pursuant to Rule 13 Part D. of the 2020 DNC Delegate Selection Rules, the Presidential candidate(s), or their authorized representative (s), have right of refusal for all District-Level, At-Large, PLEO and Alternate delegate candidates.
From Rule 10 Part A.1 & Reg. 4.16. Individuals shall be eligible for the pledged Party Leader and Elected Official (PLEO) delegate positions according to the following priority: big city mayors and state-wide elected officials (to be given equal consideration); state legislative leaders, state legislators, and other state, county and local elected officials and party leaders.
For a complete copy of the Kansas Democratic Party’s Delegate Selection Plan, please visit: www.KansasDems.org/2020Primary
In order to ensure the proper receipt of all 2020 DNC Convention Delegate Selection applications, applicants will receive a mailed or emailed notification from the Kansas Democratic Party to confirm that the application was received. If your confirmation does not arrive within ten days, your application was not processed by the KDP.
KDP OFFICE USE ONLY:
Date/Time Received:
Entered By: