Name:

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State: AZ    Zip Code:      Email:

Telephone number:     Your Legislative District:
NOTE: If you do not know your legislative district, you can find out at http://azredistricting.org/mapping/default2.asp

Yes, I am a registered voter. I am a: Republican Democrat Independent
No, I am not yet a registered voter.
NOTE: If you are not registered to vote, you may do so by calling the Voter Registration Hotline at
1-877-THE-VOTE, or obtain your voting registration on line at: https://az.gov/webapp/evoter .
To learn about voter registration deadlines, go to: http://www.sos.state.az.us/election/2004/info/ImportantDates.htm .
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Please indicate those activities in which you are willing to participate:
Receive electoral information only.
Participate in District, Regional or Statewide informational forums.
Work on the campaign of an identified candidate.
Conduct fundraising activities.
Collect petition signatures.
Display/distribute campaign materials at your home or place of work.
Maintain contact with your elected officials on specific issues.

Press the SUBMIT button to enroll, or the RESET button to clear the form: