DOCC Mobile Voter Registration Form

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Thank you for your interest in voting!

Please fill out the information below and a Volunteer Deputy Registrar will contact you to register you to vote. We can visit you at your residence, your place of work, or anywhere else that is convenient to you. We are happy to come and register just you, but we can also register your family members, friends, and co-workers if they are interested.

Please fill out the form below and we will reach out to determine a time to get you registered to vote.

Full Name *

Email *

Phone number

Address *

Zip Code

County of Residence

Are you a U.S. Citizen?

Yes

Clear selection

You must be at least 17 years and 10 months of age on the date you apply to register to vote. Are you 17 yrs and 10 months of age?

Yes

Clear selection

What is the best way to reach you? *

Phone

Mail

Other:

What is the best time of the day to reach you? *

Morning

Afternoon

Evening

Submit

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