Committee Registration Form

Committee Name: *

Alternate Name:

Street Number:

Street Name. *

Address Line2:

Town:*

State:*

Zip:*

User Name:*

Password:*

Email:

Phone Number:*

CHAIRPERSON

Last Name:*

First Name:*

Middle:

Occupation:*

Place of Principal Employment:*

Email:

Phone Number:

Physical Address:

Street Number

Street Name*

Address Line2:

Town:*

State:*

Zip:*

Mailing Address:( Same as Physical Address )

Street Number

Street Name/ P.O.Box

Address Line2:

Town:

State:

Zip:

TREASURER***Must be a N.H. Resident(RSA 664:13)

Last Name:*

First Name:*

Middle:

Occupation:*

Place of Principal Employment:*

Email:

Phone Number:

Physical Address:

Street Number

Street Name*

Address Line2:

Town:*

State:*

Zip:*

Mailing Address:( Same as Physical Address )

Street Number

Street Name/ P.O.Box

Address Line2:

Town:

State:

Zip:

PURPOSE OF COMMITTEE:

Indicate the election(s) for which the committee is registering:

Election Year / Type:*

Primary General Other

Other:

Statement of Independent Expenditures

The Committee will not be making independent expenditures.
Independent Expenditures will be made with respect to the following candidates.

		In Support of	In Opposition to
Name of Candidate

Click here to add more candidate

OTHER OFFICERS

Last Name	First Name	Street#	St. Name	Town	State	Zip	Place of principal employment	Occupation

Click here to add more Officers