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Town of Monument Monument Town Clerk 645 Beacon Lite Road Monument, CO 80132 (719)884-8035 Fax: (719)884-8011 [EMAIL REDACTED] NEW COMMITTEE REGISTRATION FORM (1-45-108, C.R.S.) Please use this form in you are registering a new committee for Colorado campaign finance purposes. Independent Expenditure Committees Use Secretary of State Form CPF-37 Select Only One Committee Type: o Candidate Committee o Political Committee o Small Donor Committee o Issue Committee o Small Scale Issue Committee o Recall Committee Committee Name: Name should be descriptive. Include office, organization name, etc. Committee Address (physical): Committee Address (mailing): Phone Number: Alternate Ph. Fax Web Address: Purpose/Office Sought: (Include party, office, district & election year, if applicable) Financial Institution Information: Institution Name: Institution Address: Authorized Agents’ Contact Information: Registered Agent: Designated Filing Agent: (Optional) Name: Name: Phone Phone E-mail: E-mail: Alternate E-mail 1: Alternate E-mail 1: Alternate E-mail 2: Alternate E-mail 2: Registered Agent’s Signature: X Date: Designated Agent’s Signature: X Date: Candidate Committee Complete the Following: Print Candidate Name: Candidate Address (include mailing): Candidate Signature: X: Date: ---PAGE BREAK---