Please print this page, complete the form and mail to your registrar of voters. To find the correct address for your parish, click here.
Date:
To the Registrar of Voters, Parish of _____________________
I am now registered in the _________ Precinct of Ward ____________
Please
note: Helpful, but not required.
My
party affiliation is Democratic (or Independent).
I
now desire to change said record, and hereby affiliate myself with the
Republican party.
Address:_____________________
_____________________
_____________________
SSN:
________________________
Phone
No.:
________________________
Printed
Name: ____________________________________
Signature of Applicant: _____________________________