TO MAIL FORM, SEND TO:
MONROE COUNTY BOARD OF ELECTIONS
ATTN: REPUBLICAN INSPECTOR COORDINATORS
39 WEST MAIN STREET ROOM 106
ROCHESTER, NY 14614
We’ll be in touch with you soon!
YES, I am interested in becoming a
POLL WORKER
My contact information is listed below:
NAME: _____________________________ DATE_________
ADDRESS: ________________________________________
______________________________, NY _______________
HOME PHONE: ______________ CELL: ________________
EMAIL ADDRESS: ___________________________________
CURRENTLY REGISTERED AS: _________________________
CITY / TOWN / VILLAGE
ZIP CODE
09/22/2020