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Canvassing Intake Form
Please complete this form to join a team working to clean up our voter rolls.
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1
Name (Please scroll down and click "Next" to continue)
First Name
Last Name
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2
First Name
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3
Last Name
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4
Email (Look for an email from NoReply@jotform.com after submitting form)
*
This field is required.
example@example.com
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5
Cell Phone Number
*
This field is required.
Please enter this format: No parenthesis. Area code required. 111-555-1212
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6
{lastName}, what County do you live in? (Please scroll down to make your selection)
*
This field is required.
Alachua County
Baker County
Bay County
Bradford County
Brevard County
Broward County
Calhoun County
Charlotte County
Citrus County
Clay County
Collier County
Columbia County
DeSoto County
Dixie County
Duval County
Escambia County
Flagler County
Franklin County
Gadsden County
Gilchrist County
Glades County
Gulf County
Hamilton County
Hardee County
Hendry County
Hernando County
Highlands County
Hillsborough County
Holmes County
Indian River County
Jackson County
Jefferson County
Lafayette County
Lake County
Lee County
Leon County
Levy County
Liberty County
Madison County
Manatee County
Marion County
Martin County
Miami-Dade County
Monroe County
Nassau County
Okaloosa County
Okeechobee County
Orange County
Osceola County
Palm Beach County
Pasco County
Pinellas County
Polk County
Putnam County
St. Johns County
St. Lucie County
Santa Rosa County
Sarasota County
Seminole County
Sumter County
Suwannee County
Taylor County
Union County
Volusia County
Wakulla County
Walton County
Washington County
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7
What is your level of canvassing experience?
*
This field is required.
None
Very Little
Some
Experienced
Very Experienced
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8
How would you like to contribute?
*
This field is required.
We primarily need canvassers but county leaders also need other types of support from time to time.
Canvassing
Phone Banking
Data Entry
Administrative Support
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9
Availability?
*
This field is required.
1 Hr/week
2-3 Hrs/week
4-5 Hrs/week
1 Hr/week
2-3 Hrs/week
4-5 Hrs/week
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10
I agree to represent myself as a volunteer community canvasser with Defend Florida. I will never represent myself as a canvasser associated with any state or local government agency.
We are all volunteers - we do NOT represent any official organization or agency. Be truthful and transparent in your conduct.
I agree
I disagree
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11
I agree to always canvass in teams or pairs. I will not canvass alone.
You must take personal responsibility for your safety and well being. Always be with others in your canvasing.
I agree
I disagree
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12
Please contact Cheryl at Cheryl@DefendOurUnion.org AFTER watching the upcoming training video. You agree that you will not canvass on behalf of Defend Florida until you have contacted Cheryl and been integrated onto a team.
I agree to complete the training and contact Cheryl before I start canvassing
I disagree
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