Alternate Judge Acceptance

Alternate Judge Information for Precinct *
Party Affiliation: 
 
 
*Last Name *First Name  M.I.
 
*Residential Address (where your are registered to vote) 
Mailing Address (if different from above)
   
*City  *State *Zip Code
   
E-Mail Address
*Home Phone
Cell Phone Number
Other Phone Number
 
*Please Check One of the Following

If you Checked "No", who will be able to serve in your place?
 
Last Name First Name M.I.
Phone Number
 
Comments
 
Please make sure that you complete all fields that are preceded by a (*).