Vote By Mail Application

Name *

First Name

Last Name

Address Where You Are Registered to Vote (required)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Apply for a mail-in ballot for ALL future elections *

By requesting a prefilled application from ACDC, I agree to apply for a mail-in ballot for all future elections, unless I request otherwise in writing to the Atlantic County Clerk's Office.

Checkbox

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