During the sixty-first (61st) and sixty-second (62nd) day preceding a primary for election of delegates to a national convention, each voter desiring to be a delegate at the forthcoming convention shall, on the form that shall be provided by the secretary of state, sign his or her name as it appears on the voting list and file, not later than four (4:00) p.m. of the date of filing with the secretary of state, a declaration of candidacy which shall include the following information:

(1)  His or her name and address as they appear on the voting list, party designation, place and date of birth, and length of residence in the state and in the town or city where he or she resides.

(2)  A statement that, if elected, he or she would comply with all party rules of the national committee of the party designated in subdivision (1) of this section relating to delegates to national conventions and conducting of national conventions.

(3)  At the same time as the declaration of candidacy is filed, the appropriate pledge of support form provided to the secretary of state by the political parties must be filed by the candidate for delegate.

(4)  If any candidate for delegate does not thereafter wish his or her name to appear on the ballot, the candidate shall, at least forty-nine (49) days prior to the date for the primary, file an affidavit with the secretary of state stating his or her name may not be placed on the ballot and the secretary of state shall not place that candidate’s name on the ballot.