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

    This field is not part of the form submission.

27. Submit

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