Signup Form

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip:

Home Phone:

Work Phone:

Other Phone:

*E-mail:

*Verify E-mail:

My preferred method of contact is:
Home
Work
E-mail
Other

*Are you a registered voter?
Yes
No

*County of voter registration:

Are you a full time student between the ages of 15 and 17?
Yes
No

Are you currently enrolled at a public or private educational institution, including a university, college, junior or community college, high school or vocational and technical school, located within the state of Missouri?
Yes No

Did your place of business, academic institution, or association encourage you to become a poll worker?
Yes
No
If Yes, please provide your business or organization name:

I learned about the opportunity to be a poll worker from:
If Other, please specify:

I have the following skills that could be useful as a poll worker (check all that apply):

   I am proficient and comfortable with most computers
   I am a “people person”
   I am fluent in Spanish
   I am fluent in another foreign language
   I have a reliable car that would enable me to drive between polling locations

Election authorities are required by Missouri statutes to have an equal number of Democratic and Republican election judges at the polls (115.081, 115.087, RSMo).
Please select one of the following options:

I am interested in being a Democratic Election Judge
I am interested in being a Republican Election Judge

If you choose to work as a Democratic or Republican election judge, your name will also be forwarded to the chairman of that party in your county of voter registration per state statutes.

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