CareVote Voter Registration Table
Please fill out the information below to request a CareVote Voter Registration table at your agency. Any questions, email
carevote@providers.org.
Agency name
Your first and last name
Your email
Voter registration point person name (if it is you, write "N/A")
Voter registration point person's email (if it is you, write "N/A")
Do you want to set up a CareVote Voter Registration table at your agency?
Yes
No
When and where you would like the voter table to be.
Do you have volunteers to staff table?
Yes
No
Can photos from the event be used for social media and news publications?
Yes
No
Contact Information