Pulaski County Republican Committee
www.pulaskigop.org

Pulaski County Republican Committee Filing Form - Filing Fee: $35.00

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I, a resident and qualified voter of Pulaski County, Arkansas, do hereby file as a candidate for the position of (Check one) Precinct Committeeperson or Precinct Chairperson to represent Precinct on the 2012-2014 Pulaski County Republican Committee for the term ending with the 2014 Republican primary election.
                                                                                  Filed this day of , .
Signature ______________________________________    
Address City Zip
Main E-mail Other E-mails
Home Phone Cell Phone Work Phone Ext.

Areas of Inerest (Optional, select all that apply):

PCRC Standing SubCommittees: Campaigns/Elections:
Finance Issue campaigns 
Educational/Leadership Training Local/county candidates/campaigns
(JP, County Judge, Sheriff, etc.) 
Candidates State Rep/State Senate campaigns 
Membership Recruitment Statewide/Federal campaigns
(Governor, President, US House/Senate, etc.) 
Public Relations    
Ballot Security    
Rules    
Additional Comments:

Complete, print and mail with your $35.00 filing fee to PCRC, PO Box 55241, Little Rock, AR  72215 before the February 2, 2012, PCRC meeting.  Otherwise, bring to the meeting.

(Leave this part blank)

Received of __________________________________, Precinct # _____, a filing fee in the amount of $35.00.

By: ____________________________________                 Date: ____________

1/6/12