Bath County Republican Committee
P. O. Box 132
Warm Springs, Virginia 24484
(540) 996-4422
www.bathrepublicans.org
Mass Meeting Pre-filing Form
The Bath County Republican Committee Mass Meeting will be held on June 17, 2010 at 7:00 p.m. at the Bath County Library in Warm Springs.
I would like to pre-file for the following positions (Please Check):
_____ Chairman
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ________________________________________ State: __________ Zip: __________________
Phone: _________________________________ E-mail: _____________________________________
I certify that I am a resident and registered voter in Bath County, Virginia, and a member of the Republican Party.
Signature: __________________________________________________________________________
MAIL COMPLETED PRE-FILING FORM TO THE ABOVE ADDRESS.
FORM MUST BE RECEIVED BY 5:00 PM on JUNE 4th, 2010.
Authorized by Bath County Republican Committee
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