Form Center

2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address*
16. Political Party*
    -- Select One --DemocraticRepublicanIndependentWorking FamiliesGreenUnaffiliated (No Party)OtherI'm too young to register
18. What is your voting precinct?*
    -- Select One --77-1 Edgewood School77-2 Northeast School77-3 Mtn View School77-4 Chippens Hill MS78-1 Bristol Eastern HS78-2 West Bristol School79-1 South Side School79-2 Elks Lodge79-3 Greene-Hills School
20. Multilingual?

    If you speak and read language(s) other than English, please indicate above.

22. Have you ever worked the polls on Election day?*

    1. Yes
    2. No
24. If yes, in what capacity?
26. Location Preference (choose one)*

    1. 77-1 Edgewood School
    2. 77-2 Northeast School
    3. 77-3 Mtn View School
    4. 77-4 Chippens Hill MS
    5. 78-1 Bristol Eastern HS
    6. 78-2 West Bristol School
    7. 79-1 South Side School
    8. 79-2 Bristol Arts & Innovation Magnet School
    9. 79-3 Greene-Hills School

    Please indicate a specific location you prefer (we cannot guarantee but will do our best to accommodate).

28. Confirmation of Commitment*

    1. I confirm that I have read "Poll Worker 101" and that I am willing and able to work a 15-hour day beginning at 5:00 AM.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field