Step 2: Complete Your ApplicationComplete this form and we will email you a filled-in voter registration application for you to print and deliver or mail to your local county election commissionThis is what type of registration?*New RegistrationRecord Update/Change (e.g., Address, Party Affiliation, Name, Signature)Request to Replace Voter Information CardAre you a citizen of the United States of America?*YesNoI affirm that I am not a convicted felon, or if I am, my right to vote has been restored.*YesNoI affirm that I have not been adjudicated mentally incapacitated with respect to voting or, if I have, my right to vote has been restored.*YesNoI understand that voter registration records are public records, open to inspection by any citizen of Florida, excluding the social security number, driver’s license number, and the Department of Safety and Homeland Security ID number.*YesNoI understand that giving false information to register to vote or attempting to register when not qualified is a felony punishable by not less than two (2) years nor more than twelve (12) years imprisonment or a fine of $5,000 or both.*YesNoYou are not eligible to register to vote.Based on your answers, you are not eligible to register to vote at this time. You may not proceed with voter registration because of your answers.Restoration of Voting Rights NeededBased on your answers, you will need to visit the link below to learn about restoring your voting rights. Click here Last Name*First Name*Middle NameSuffixPlease provide your street address (legal residence - no P.O. BoxStreet Address*Apt #City*County*AlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSanta RosaSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashingtonZip*I have a different mailing address Yes Mailing AddressAddressApt #CityStateZipPlease provide the address where you were last registered to vote.Street Address*Apt #City*State*Zip*Please Provide your former first and last name (if name has changed).Gender*MaleFemaleState or Country of Birth*PhoneEmail me sample ballots. If option is available in my county.YesNoEmail Party Affiliation (If left blank, you will be registered without party affiliation)Florida Democratic PartyRepublican Party of FloridaNo party affiliationMinor partyParty NameRace/Ethnicity (Check only one)American Indian/Alaskan NativeAsian/Pacific IslanderBlack, not of Hispanic OriginHispanicWhite, not of Hispanic OriginMulti-racialOtherRace/Ethnicity (Other)Check one if applicableI am an active duty Uniformed Services or Merchant Marine memberI am a spouse or a dependent of an active duty uniformed services or merchant marine memberI am a U.S. citizen residing outside the U.S.Check if applicable I will need assistance with voting. I am interested in becoming a poll worker. Hidden FieldsFull NameAddress Label TextMessageOptIn This iframe contains the logic required to handle Ajax powered Gravity Forms.