I, ______________________________, intend to run for _________________________of the
Democratic Party of Georgia. I affirm that I am/am not a current State Committee Member. I have made an X under the statement that is true for me. _________ As a current State Committee Member, I serve under __________________ County or I am an At-large member. _________Conversely, I am not a current State Committee Member and therefore the 30 signatures of current State Committee Members supporting my candidacy are attached as Exhibit A.