Request a Multipartisan Assistance Team

Request a Multipartisan Assistance Team

Pender County Board of Elections
Covered Facility Type
Name of Covered Facility
Number of Mobile Individuals Requiring Services
Number of Bed-Bound Individuals Requiring Services
Assistance with absentee request formsAssistance with voter registration formsAssistance with absentee ballots
Your Name

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred date and time

MonthDayYear
Date
Hour MinutesAM/PM Option
Any other specific date and time, if the above selection is not suitable.

MonthDayYear
Date
Hour MinutesAM/PM Option
Please provide any other details or questions about this request.
Should be Empty: