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Sign up to be a Vot-ER Civic Health Partner!

Primary Contact Information

Title

First Name

*

Last Name

*

Suffix

Email

*

Phone

*

Zip Code

*

What is the role of the primary contact at this institution/organization?

*

Vot-ER is committed to providing support and resources to help you get out the vote! To do so, we may send periodic text messages. How often would you like to be texted?

*

Vot-ER is committed to providing support and resources to help you get out the vote! To do so, we may send periodic text messages. How often would you like to be texted?

A

I agree to receive essential messages from the Vot-ER team

B

I agree to receive essential messages and occasional messages to help scale my impact

C

I do not wish to receive any text messages from Vot-ER