Registrar of Voters

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Name as Registered *

First

Middle

Last

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Date of Birth *

Birth Date

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Email Address *

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Residence Address *

Number and Street

City

ZIP

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Mailing Address

If different from Residence Address.

Number and Street

City

State

ZIP

Country

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Sample Ballot Pamphlet Options *

Sample Ballot Pamphlet Options

I no longer want to receive my sample ballot booklet by mail. I’ll use the online booklet instead.

I previously opted out of receiving my sample ballot booklet by mail, but would like to start receiving it again.

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Authorization *

To confirm your identity, please select one of the following

California Driver License or Identification Card Number

Enter California Driver License or Identification Card Number

Last Four Digits of Your Social Security Number

Enter Last Four Digits of Your Social Security Number

Sample Ballot Pamphlet Opt-Out Form

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_____________________________________

Name as Registered *

_____________________________________

Date of Birth *

_____________________________________

Email Address *

_____________________________________

Residence Address *

_____________________________________

Mailing Address

_____________________________________

Sample Ballot Pamphlet Options *

_____________________________________

Authorization *

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To show that you are not a robot please enter the code you see below.

Sample Ballot Pamphlet Opt-Out Form

All fields with an asterisk (*) are required._____________________________________

Name as Registered *

_____________________________________

Date of Birth *

_____________________________________

Email Address *

_____________________________________

Residence Address *

_____________________________________

Mailing Address

_____________________________________

Sample Ballot Pamphlet Options *

_____________________________________

Authorization *

_____________________________________

To show that you are not a robot please enter the code you see below.

All fields with an asterisk () are required.*
_____________________________________