Republic of Florida Congress Delegate Application
Please Read Carefully: Information submitted in your application will be forwarded to the state registrar for consideration. The decision regarding your application by your state delegation is final. Applications should only be submitted ONCE. Incomplete applications will not be considered. All personal and contact information shared with the SNC Committee on this site will be held in strictest confidence and used only for the stated purposes of organizing and supporting the SNC.

General Information:

Name:  Mr. Mrs. Miss Dr. Rev. Pastor    First       Last

Mailing Address:  Street 

City or Town:   State: Florida   Zip Code:

Place of Birth:  City, State

Email:

Phone:

Qualification:

Are you a male at least 25 years of age?  Yes  No

Have you resided in Florida for a period of not less than 10 continuous years?  Yes  No

Do you warrant that you are of good moral character, have no criminal record, and have never been convicted of a mal in se crime; that is, a thing “evil in itself,” (murder, rape, arson, kidnapping, violent assault, armed robbery, etc.)  Yes

I have read and understand the Southern National Congress Florida Delegation statement on qualifications for Participation  Yes

Please tell us about any talents, skills, previous experience, or educational attainment that you believe would be an asset for the Southern National Congress. Please restrict your comments to information that will be helpful in the Florida delegation's consideration of your application in regard to your ability and commitment to the Southern Cause: