Ballot Harvesting

BALLOT HARVESTING

FOR STAFF USE ONLY

Staff Member Collecting

Name of Staff Member(Required)

First Name Last Name

Congressional District of Staff Member(Required)

Please enter a number from 1 to 52.

Voter Information

Name of Voter(Required)

First Middle Initial Last

Date on Ballot(Required)

Address of Voter(Required)

Street Address Address Line 2 City ZIP Code

County of Voter(Required)

Ballot Collection

Date of Ballot Collection(Required)

Time of Ballot Collection(Required)

Name of Ballot Collector(Required)

First Last

Authorized Returner

Name of Authorized Returner(Required)

First Last

Relationship to Voter(Required)

Date of Delivery to ROV(Required)

Time of Delivery to ROV(Required)

Paid for by the California Republican Party. Not Authorized by any Candidate or Candidate’s Committee. 1001 K Street, Fourth Floor, Sacramento, CA 95814. P: 916-448-9496 | F: 916-448-9497. Federal ID# C00140590 | State ID# 810163

To Contribute via Check or Credit Card through the MAIL rather than online, download and print this form.

ABOUT

ELECTION INTEGRITY

CONVENTION

RESOURCES

By providing your cell phone or mobile phone number you are consenting to receive calls and texts, including autodialed and automated calls and texts, to that number with campaign notifications from the California Republican Party. Reply “STOP” to opt-out & “HELP” for help. View Privacy Policy for more info.

IN THE NEWS

CAREER OPPORTUNITIES

REGISTER TO VOTE