Title TitleMr.Mrs.Ms.Dr.Other- describe in "additional info" box below

First Name

Middle Name

Last Name

Suffix SuffixSr.Jr.IIIIIOther- put in "Additional Info" box below

Maiden Name (if applicable)

Preferred Telephone

Email Address

County of Residence

State of Residence

Address as appears on your voter registration

City

Zip

List all social media profiles. Please include a link if possible.

What other groups are you involved with? (political, grassroots)

Using Excel as a comparison, what is your skill level? Using Excel as a comparison, what is your skill level? I am proficient with Excel I am comfortable with Excel I am a beginner with Excel What is Excel?

Can you invest ᐳ$150 in a software liscence? Can you invest ᐳ$150 in a software liscence? Yes No

Describe your interaction/history with your local Board of Elections

Do you agree to operate fully legally & in cooperation with direction from Verified Elections and/or Eagle AI? Do you agree to operate fully legally & in cooperation with direction from Verified Elections and/or Eagle AI? Yes No

Do you agree that you are fully responsible for your own actions and that Verified Elections and Eagle AI are in no way responsible for your actions? Do you agree that you are fully responsible for your own actions and that Verified Elections and Eagle AI are in no way responsible for your actions? Yes No

Please provide any additional info you want us to know!