Officer of Election Interest Form

I am a registered voter of Virginia and would like to be placed on a list of potential Election Officers

Locality Where I am interested in serving:

First Name

Last Name

Suffix

Residence Address

City

State

Zip

Year of Birth

Primary Phone

My primary phone is a cell phone

Cell phone service provider

Can we text you regarding your Officer of Election Interest Form? Yes No

Are you willing to work a precinct away from your neighborhood? Yes No

Do you have access to reliable transportation? Yes No

If yes, how many miles away are you willing to travel (one way)?

Additional Languages