Barack Obama | Change We Need | Help Us Make Every Vote Count!

Email: *

First Name: *

Last Name: *

Address where you are registered to vote: *

City: *

State:

Zip / Postal Code: *

Cell Phone: *

County : *

Would you be willing to serve as an official election worker for the county or city?:

Yes

Are you a law student?:

If you are an attorney, how long have you been a member of the bar?:

Are you able to work Election Day?:

Are you able to work for 3-4 days before Election Day?:

Will you have access to a car?:

Are you willing to travel around election day?:

To which states?

Preferred State 1:

Preferred State 2 :

Preferred State 3 :

Do you speak any languages other than English?:

Are you available for more than 10 hours/week during the fall?:

Have you done election protection work before?:

Have you done campaign field work before?:

Have you ever served as a credentialed poll watcher in your county? :

Please upload your Resume (optional):

Any additional Notes/Comments (e.g., special qualifications, communities in which you have a particular interest, etc.):

* denotes required field