I attest that I am a registered Republican Party member in the State of Nebraska and reside for voting purposes at the address provided herein. The information submitted is accurate and complete. I understand that the delegate registration address I am submitting must match my voter registration address for check-in at my county convention. If there is a mismatch, I will not be credentialed and cannot participate in the county convention.
I understand that falsification may result in a violation of Neb. Rev. Stat. §32-1507, constituting a Class IV misdemeanor for false swearing regarding political party affiliation.