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Poll Worker Signup Form

2. Name

4. Address

6. City

7. State

8. Zip

10. Home Phone

11. Cell Phone

13. Work Phone

14. Email

16. Best Time to Call
    Best Time to Call

20. I want to serve my community and become a poll worker.

    I want to serve my community and become a poll worker.

22. I want to serve as:

    1. Clerk
    2. Inspector of Elections

    1. Judge of Elections

23. If there are no vacancies in my precinct, I am will to:

    1. Have my name placed on a list for future use in my precinct
    2. Work in a different precinct

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field