DCTAG

Registration Form

Please fill in the form below.
Signature*
Full Name*

PrefixFirst NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ward
Petitions can be dropped off at the Mayor's Office on Arican Affairs

2000 14th Street, NW, Washington DC 20009

or emailed to Soro Yah Kingnaman at Soro.Kignaman@dc.gov
Should be Empty:

Registration Form