Kapawe'no Voter Registration Form Question Title * 1. By checking below I agree to the following terms: That data provided herein shall comply with the Freedom of Information and Protection of Privacy Act, and the Access to Information Act; my personal data will only be used for voter registration. Yes. Question Title * 2. First Name Question Title * 3. Middle Name(s) Question Title * 4. Last Name Question Title * 5. Clan Chalifoux Freeman Halcrow Other (please specify) Question Title * 6. Date of Birth Date / Time Date Question Title * 7. Please provide your contact information Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Done
