THANK-YOU for signing up to be a Poll Observer! Please complete the following form to help in your placement.

First Name

Last Name

Phone

Email Address

Address

City, State, Zip

What day(s) can you work? (check as many as you want) What day(s) can you work? (check as many as you want) Wednesday, April 27 Thursday, April 28 Friday, April 29 Saturday, April 30 Sunday, May 1 Monday, May 2 Tuesday, May 3 (Election Day) Wednesday, May 4 Thursday, May 5 Friday, May 6 Saturday, May 7 Sunday, May 8 Monday, May 9 Tuesday, May 10 Wendesday, May 11 Thursday, May 12 Friday, May 13 Saturday, May 14

Of the date selected, how many TOTAL days can you work?

How many miles are you willing to travel?

Please provide any additional information that would be important for your placement.