DEPARTMENT OF PUBLIC SAFETY HELP DESK FORM

2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Date You Would Like to Schedule*
9. Time You Would Like to Schedule*
11. Approximate Number of Attendees*
13. Location of the Demonstration (Please enter address, city, state, and zip code)*
15. We can provide any of the following information. Simply let us know which items you would like, where to send the material, and how to get in touch with you:

    • Newsletter articles
    • Brochures about the new system (in Spanish and English)
    • Sample "How-to-Vote" flyers in Spanish and English (may be copied on 8.5" by 11" paper)
    • A "How-to-Vote email for distribution to your employees, organizational members, or friends
    • Sample "How-to-Vote" stuffers for payroll envelopes (size 6" by 3.5", will fit three to a letter-sized page)
17. Additional Comments
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

* indicates a required field