2019 NATIONAL PROVINCIAL ELECTION POLL PLEASE BE ADVISED THAT ANY INFO CAPTURED HERE, IS PRIVATE AND CONFIDENTIAL. ONLY THE DEMOCRATIC ALLIANCE WILL HAVE THIS INFORMATION, AS IT GIVES THE DA AN INSIGHT AS TO WHERE AND HOW WE ARE DOING IN THE POLLS. 2019 IS AN ELECTION THAT COULD MAKE OR BREAK SOUTH AFRICA. I MYSELF, AS A SOUTH AFRICAN CITIZEN, AM AFRAID OF LEAVING MY HOUSE UNATTENDED WHENEVER I GO TO WORK OR EVEN TAKE MY FAMILY OUT. As a South African, I am afraid of taking my wife out to dinner, as I don’t feel safe having dinner in a public place full of people. I'm afraid of getting into my driveway, day or night, in case I get hijacked or murdered. I don’t go through a day, where I don’t know of a robbery, assault, murder and all kinds of atrocities that is taking place somewhere, close to where I live. Lawlessness and corruption reigns in South Africa. I must wonder what will South Africa be like in another 5 years, if we stay on this path. It is now time my fellow South Africans, to unite and make a stand to stop this madness. WILL YOU LEND US YOUR VOTE in the 2019 national and provincial elections, will you vote DA ? YesNoMaybe Would you like to be a DA member? YesNoMaybe Would you like to volunteer, to help us on Election Day at the Polling Stations? YesNo Please fill in your personal details below First Name (required) Last Name (required) Physical Address(required) ID Number(required) Cellphone Number(required) Email Address(required) Electronic signature acceptance(required) POPIA DISCLAIMER By submitting this form I consent to allow the Democratic Alliance to process my information for a lawful purpose, in-line with the DA's activities and in compliance with other legislation. The DA will never share your information with a third party. I consent to receive occasional future communication from the DA sharing important news and information about campaign and election activities, as well as fundraising appeals. For any additional queries please send an email to darocha.carlos@gmail.com I Agree