* Denotes required fields. Form cannot be accepted if the information is not complete.

* First Name

* Last Name

* Address

* City

* State

* Zip

Home Phone

Work Phone

Other Phone

* E-mail

* Verify E-mail

* My method of preferred contact is

Home

Work

Other

* Are you a registered voter?

Yes

* County of voter registration

Are you a full time student between the ages of 15 and 17?

Yes

Are you currently enrolled at a public or private educational institution, including a university, college, junior or community college, high school or vocational and technical school, located within the state of Missouri?

Yes

Did your place of business, academic institution, or association encourage you to become a poll worker?

Yes

* I learned about the opportunity to be a poll worker from:

I have the following skills that could be useful as a poll worker (check all that apply)

I am proficient and comfortable with most computers

I am a “people person”

I am fluent in Spanish

I am fluent in another foreign language

I have a reliable car that would enable me to drive between polling locations

Election authorities are required by Missouri statutes to have an equal number of Democratic and Republican election judges at the polls ( §115.081, §115.087, RSMo).

Please select one of the following options:

I am interested in being a Republican Election Judge

I am interested in being a Democratic Election Judge

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