Site hosted by Angelfire.com: Build your free website today!

 

Are you a United States citizen? If NO, you cannot register to vote.
(Required)		Yes   No
 
I affirm I am not a convicted felon, or if I am, my rights relating to voting
have been restored? (Required)		I affirm.
 
I affirm I have not been adjudicated mentally incapacitated with respect to voting
or, if I have, my competency has been restored. (Required)		I affirm.

 

 



Date of birth (example: 07/04/1976)
(Required)   

 /  / 


Florida Driver License/Florida ID Card number (Please specify as follows...)
If you have a current FL DL# or FL ID card, you must provide the number here. 
If you do not have either of the above, then you must provide the last 4 digits of your SSN. 
If you have not been issued a FL DL#, FL ID#, or SSN, please specify -- 
  "I do not have any of the above forms of ID": 
I have a Florida Driver's license or Florida ID
I only have a Social Security ID
I do not have any of the above forms of ID
Enter FL DL#/FL ID below
Enter Last 4 digits of SSN# below


Name (If you use a Suffix that is not listed, please include it in the Last Name field)
First Name
Middle Name
Last Name (required)
Suffix


Residential Address 
Street Address
Apt/Lot/Unit
City
Zip Code


Mailing Address
(if different from above)
Street Address
Apt/Lot/Unit
City
Zip Code


Party Affiliation -- check one box only (see instructions)
  • If you wish to register with a major political party, click the circle preceding the listed party with which you wish to affiliate.
  • If you wish to register with a minor political party, click the circle preceding "Other Party" and print the name of the party with which you wish to affiliate.
  • If you wish to register without party affiliation, click the circle preceding "No Party Affiliation."



Democratic Party
Republican Party
Other Party
(Choose State-registered party here...)   
No Party Affiliation


Race/Ethnicity
Asian or Pacific Islander
Black, not Hispanic
Hispanic
White, not Hispanic
American Indian or Alaskan Native


Gender                                

M F

Do You Need Assistance to Vote?   
Yes   No

I am Active Duty Military/Merchant
Marine
Yes No

I am a Dependent of Active Duty  
Military/Merchant Marine
Yes No

I am a US Citizen Residing             
Outside the US.    
Yes No