2. I am interested in serving as: (Check all that apply)*

   1. Judge of Elections
   2. Inspector of Elections

   1. Clerk of Elections
4. Are you willing to travel to a precinct not closest to your home?*

   1. No

   1. Yes
5. How many miles?
7. Name:*
9. Street Address:*
11. City:*
12. State:*
13. Zip Code:*
15. Home Phone:*
16. Work Phone:
18. Best Times to Call:*
20. Email:*
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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