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Vot-ER Custom Materials

Thank you for your interest in ordering Vot-ER materials for your institution or team! Upon filling out this form, you'll receive a custom, digital suite of resources designed to help you integrate voter registration into your daily practice. These digital resources are free of charge.

Step 1 of 3: Basic Information

First Name

Last Name

Email Address

Phone Number

Untitled checkboxes field
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Your Occupation

Organization Name

What group, team, department, etc. are you ordering for?

What state is your organization in?

The majority of my patients are (select all that apply):

The majority of my patients are (select all that apply):

My institution views itself as a space that is designed to serve (select all that apply):

My institution views itself as a space that is designed to serve (select all that apply):

Which of the following best describes you?

Which of the following best describes you?
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B
C
D
E