®NRA Us “A Freedom Action Foundation 11250 Waples Mill Road Fairfax, Virginia 22030 Code: 0 antl HLOA 3HL ESTE Ly We cole Moy motel mC) FED IFN Lb A D9JOAd 0} 91 id MON paiedaig 31,no, 3Nng a9e/q Snosahueg & SI pjioM SULDon’t Take Anything for Granted -- Especially Your Rights! You always hope for the best, and today your rights are secure. But you never know about tomorrow. We don't know what dangers may loom in the future. Our country is at a crossroads, and no one can say for sure what choices or challenges may be ahead. You're prepared for today’s challenges. But i's impossible to know what the future may demand of you. The only definitive action you can take now is to be prepared for whatever may come. So why risk your rights? Why let someone else decide? Take action now for a better future — by registering to vote. Only by registering to vote, and casting an informed ballot, can you truly make a difference. Our nation is closely divided, and elections are often decided by a handful of votes. Your rights could be in jeopardy. Don't risk feeling regret over outcomes in which you didn't take part. Don't risk your rights! Register to vote today! Instructions for Registering to Vot mma T hs eon air a Zon elma ot DG ate cad www.TriggerTheVote.orgVoter Registration Application Before completing this form, review the General, Application, and State specific instructions. ‘re youa lien ofthe Unied Sate ofAmerica? EJ ves (LJ) no | TH ep0c8 Tor ofico uso ony Wi you be 18 years ot nor before etcton day? Yes No Myo chectad“No" response to ether ofthese questions, donot comple orm. (ns no ety nr sang eye ar) (Gircoone) [Last Name Fst Name Wile Name(s) (Giro on) 1 Mr. Mrs. Miss Ms. JJe Seth mV, Home Aadiess ‘Apt orlot# | CityTown ‘State Zip Code 2 ‘Adress Where Vou Get Yaur Mail Dflerent From Above CiiyTown ‘State Zip Code Date of Binh "Telephone Number (optional) TD Number (Sean Sin inaction yer) Month Day Year Choice of Paty Face or Etinis Group 7 | (coctcm 7 intr stucsons for your Stato} 8B | (eeoitom 8th rstructons fr your Sa | have reviewed my state's instructions and | sweariafim that: = Lama United States ctizen 1» I meet the eligibility requirements of my state and 9 | * subscrive to any oath required * The information | have provided is tue tothe best of my knowledge under penalty of perjury. If| have provided false information, | may be fined, imprisoned, or ifn a US. citizen) deported from or refused entry tothe United States, Please sigh fullname for put may) Date: Wonth Day Year Hyou are registering to vate for the first time: please refer to the application instructions for information on-submitting ‘copies of valid identification documents with this form. Please fill out the sections below if they apply to you. this application i or @ change of name, what was your name before you chenged It? i, [Last Name First Name Middle Name(s) (Circle one) i A iss Je Sei MV you were registered before but this isthe frst time you are registering from the adess in Box 2, hal was your acdkess where you were registered before? By | Sve (route an box number ‘Apt orLot# | GiyTownGounty ‘State Zip Code Ifyou live ina rural area but donot have a street number, orf you have no address, please show on the map where you lv. 1 Wien the names he crossroads set) nearest where youve, won 2 * Draw an Xo show where youve "= Use a dot to show any schools, churches, stores, or other landmarks ‘ear where you lve, and wre the name of the landmark. C| [ean © Grocery Store ‘Weodchuck Road Publi School @ x Route #2 ifthe applicant is unable to sign, who helped the applicant il out his applicalion? Give name, adres and phane number [phone number optional) D‘STAMP NECESSARY GOVERNMENT ACCOUNTABILITY BOARD P.O. BOX 7984 MADISON, WI 53707-7984 noes yet fT Eth Fold in half and seal with tape at the top. XINO ASN 1VIDIssaO HOS