Request a trained and verified Grassroots Conservative volunteer to help you turn in your ballot
Your Name
*
First Name
Last Name
Birthday (used to verify voter ID)
*
(MM/DD/YYYY)
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which days of the week work best for you? (choose all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time of day usually works best for you? (choose all that apply)
Morning (after 9am)
Noon
Afternoon
Evening (before 8pm)
Number of Ballots in the household
*
Submit
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