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2. Please complete this form to sign up to become an Election Inspector.  After you submit, you will receive an email from a member of the Board of Elections. Thank you. 
   

4. Full Name *
6. Physical Address*
8. Mailing (if different)
10. City*
11. State
    NEW YORK
12. Zip Code*
14. Phone Contact *
15. Political Party *
    -- Select One --DemocraticRepublican

    .To become an Elections Inspector, you must be registered as a Democrat or Republican.

16. Date of Birth *
    Date of Birth
18. Email address*
Leave This Blank:


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

    This field is not part of the form submission.

22. Submit

* indicates a required field