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2. First Name*
3. Last Name*
5. Phone Number
6. Email Address
8. Date of Birth*
   Date of Birth
12. Home Address
14. Address*
16. City*
17. State*
18. Zip Code*
22. Mailing Address
24. Address
26. City
27. State
28. Zip Code
32. Comments
34. Update Your Information
    VoteWA

    If you are unsure about your voter registration status in Yakima County, visit MyVote to register to vote or update your information.

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36. 1. Receive an email copy of this form.
37. Email address

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38. Submit

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