Name you are registered to vote as:
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address where you are registered to vote:
*
We need your full address to confirm your voter registration and let you know your Election Day Polling Location and closest Early Voting Location:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
If someone on our team referred you to this form, please let us know who so they can make sure to reach out and help remind you to vote:
My Plan to Vote is:
Do you need a ride to the polls to vote?
YES I need a ride to Vote
NO I do not need a ride
If you need a ride please indicate preferred time. We will contact you to confirm.
