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Voter Registration Form |
Name |
First Last Middle |
| (Optional) |
|
| Social
Security Number |
- - |
| Gender |
Male Female |
| Birth
Date |
|
| Email: |
|
| Address
or location of where you live |
|
| City |
|
| State |
|
Zip: |
| Mailing
address if different from above |
|
| City |
|
| State |
|
Zip: |
I swear/affirm that:
Yes |
Optional Information |
| The following information is not required and may be omitted. |
| Telephone
number |
( ) - |
| Choice
of Party |
|
| Race
or Ethnic Group |
|