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Register To Vote!

Are you a citizen of the United States of America?:

Yes

No

Will you be 18 years old on or before election day?:

Yes

No

Is this the first time you are registering to vote?:

Yes

No

Have you changed your name since the last time you registered?:

Yes

No

Have you changed your address since the last time you registered?:

Yes

No

Do you receive mail at a different address?:

Yes

No

Legal Name:

Old Name:

Address:

Old Address:

Mailing Address:

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Date of Birth:

Telephone:

Party:

Ethnicity/Race:

ID Number:

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