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2. Date Received:
   ______________
3. Election Worker Response Form
   Join the Election Worker Team!

4. Walk-In ______
   Mail ______

6. ***In order to be an Election worker, you must be registered to vote in Midland County.***
8. I am interested in serving as an Election Worker for (check one or more):*

   1. Saturday elections (7:00 AM - 7:00 PM)
   2. Tuesday elections (7:00 AM - 7:00 PM)
   3. Early Voting (varying hours/days)
   4. Telephone Bank Election Day ( 7:00 AM - 7:00 PM)
   5. I am Bilingual (English & Spanish)
10. First Name*
11. Last Name*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Primary Phone Number*
21. Alternate Phone Number
22. Email Address*
24. Birth Date*
    Birth Date
25. Do you drive?*

    1. Yes
    2. No
26. Political Party Preference:*

    1. Republican
    2. Democrat
28. Comments:
30. Signature
    Sign after printing
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31. Print Only

* indicates a required field