2024 CONVENTION DELEGATE REGISTRATION FORM

MIDDLESEX COUNTY REPUBLICAN ORGANIZATION

THURSDAY, MARCH 14TH

6-7PM DOORS OPEN/REGISTRATION, 7PM START TIME

The voting will be immediately after the presentations for each/any contested office, and there could be several separate
votes if there are multiple contested offices.

MIDDLESEX COLLEGE (FORMERLY MIDDLESEX COUNTY COLLEGE)

WEST HALL PARKVIEW ROOM
2600 WOODBRIDGE AVE, EDISON, NJ

Registration form must be accompanied by a $10.00 registration fee. Deadline to register is February 25th
Registration forms/fees accepted on February 25th, 2-4 PM, at 499 Plainfield Avenue, 2nd Floor Edison, NJ
Registration Day Issues Call Rob at 908-966-1491
Questions? Contact your Municipal Chair or email us at: mcrepublicansnj@gmail.com
Delegate / Guest Registration Information – PLEASE PRINT CLEARLY
Note: All fields marked with an asterisk (*) are REQUIRED.

*Name (Print):

*Street Address:
*Town (Mail): *Zip Code:
*Voting Town:
*Ward/District:
*Congressional
District: Circle One: 6th, 12th
*Telephone:
*E-mail:
Delegate/Guest Status (check one)
You must be a registered Republican in Middlesex County by February 8, 2024 to vote at the convention.

□ Registered Republican V □ County Committee V □ Elected Official V

□ Guest □ Campaign Employee/Consultant/ Volunteer

V Reflects attendees with voting rights at the convention

Signature: Date: ______

Administrative Use Only

Municipal Chair Registration Sign off:

Board of Elections Review/Change of Status

□ Not a registered Republican □ Not an Elected Official
□ Not registered to vote □ Not a County Committee Member
□ Other

CONVENTION DAY SIGN-IN

(Registration Void if Signed Prior to Convention Day)

Signature: