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CFC Form RC Rev 9/17 Filer ID: ALL CANDIDATES & PUBLIC OFFICERS: File with the Campaign Finance Commission Georgia Government Transparency & Campaign Finance Commission 200 Piedmont Avenue S.E. I Suite 1416 - West Tower I Atlanta Georgia, 30334 REGISTRATION FORM FOR A CANDIDATES CAMPAIGN COMMITTEE (FORM RC) Any substantive changes to the registration information of a committee must be updated within 7 business days INCOMPLETE FORMS WILL NOT BE PROCESSED • If form is handwritten, it must be legible. 1 Today’s Date: Select Form Type: Original Amended 2 Committee (Full Name): Address: _ City, State, Zip: Telephone Number (optional): _ Email: 3 Campaign Committee Chairperson (full name): Address: _ City, State, Zip: _ Email : _ 4 Treasurer (full name): Address: _ City, State, Zip: _ Email : _ 5 Candidate (full name): Address: _ City, State, Zip: _ Email : _ 6 Select Office Type: Statewide State County Municipal Name of Office Sought or Held: (include district, post, or judicial circuit if applicable) I CERTIFY THAT THIS STATEMENT IS COMPLETE, TRUE AND ACCURATE. Signature of Person Registering Committee Date Party Affiliation (optional): Democrat Non Partisan Republican Other SIGN