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2. Registered Name:
   
   First Name *
3. 
   
   Middle
4. 
   
   Last*
5. 
   
   Suffix
7. Residence Address:
   
   Number & Street*
8. 
   
   City *
9. 
   
   Zip Code*
11. Number and Street
    (if different from residence address)
12. City
13. State
15. Zip Code
16. Country
18. Email Address:
    (so we may contact you quickly)
20. Voter Information Guide Options:*

    1. I no longer want to receive my voter information guide by mail. I’ll use the online guide instead.
    2. I previously opted out of receiving my voter information guide by mail, but would like to start receiving it again.
22. Digital Signature:*
    (Please enter either of (1) your California Driver's License or California ID number, or (2) the last four digits of your Social Security number.)
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field