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2. Name (as you are registered)
3. Preferred Name
4. Email Address
6. Address
8. Mailing Address (if applicable)
10. City
11. State
12. Zip Code
14. Home Phone Number
15. Cell Phone Number
17. Where are you willing to serve?

    1. Anywhere
    2. 15 minutes from home precinct
    3. Only home precinct
18. My comfort with basic technology is best described as:

    1. Fearless
    2. Confident
    3. Cautious
20. Please list any relatives who are also serving as Precinct Officials in Wayne County and their relationship to you.
21. Provide any additional information you would like to share with the Board of Elections below:
23. I am fluent in the following languages:
Leave This Blank:


25. Submit

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