Volunteer Registration Form

Contact Type *

Pronoun *

We request this information in case a voter has a specific request. We also want to know how to respectfully refer to you!

Name

First Name Last Name

Email *

Mobile Phone *

We may use this number to send SMS messages regarding volunteer opportunities. (enter 10-digit number only)

Home Phone

(enter 10-digit number only)

Street Address *

City *

Zip Code *

County *

Date of Birth *

MM/dd/yyyy

We require this information to understand our volunteer demographics and to enable us to obtain approval for those who are not of the age of consent.

Age

U.S. Congressional District

Click link above to find your representative

Are you willing to be trained to assist differently abled voters using a modified minivan that can transport voters using wheelchairs?

Check box if yes.

Other Organizations You Volunteer With

Anything else you would like to tell us about?

How did you hear about us? *

Click here to read the agreement to participate. *

Agreement to Participate: I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any program with the Rideshare2Vote Organizations, which includes the following entities (Rideshare2Vote LLC, Rideshare2Vote PAC, and Rideshare2Vote AWARE). Further, I hereby hold harmless, release, and forever discharge the Rideshare2Vote Organizations from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of or arising in connection with such volunteer efforts or my participation therein. I understand that my participation is entirely voluntary and that volunteers using vehicles or other equipment in the course of volunteer activities provide for their own expenses with no reimbursement. I hereby grant to the Rideshare2Vote Organizations and its media partners permission to identify me by my name or to publish photographs or videos of me, taken in the course of my volunteer activities or otherwise willingly provided by me, in web-based publications, print advertisements, organizational bulletins, fundraising, or other promotional uses. I currently have no known physical or mental condition that would impair my capability for full participation as intended or expected of me.

I have read and agree to the above agreement. *

See policy above.

Volunteer Registration Form

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