Registration for the 2016 Municipal Elections Saturday 5 and Sunday 6 March 2016

Please Note:The details you enter on this form, including your ID number and other personal information, is absolutely confidential. We use this information to make sure that you are still on the voters roll, which voting district you belong to and if you have recently moved into the area. On Registration day we will make sure that we keep you informed of election stuff, where to register and where to go vote.

Your Personal Information

First Name (required)

Last Name (required)

Physical Address(required)

ID Number(required)

Cellphone Number(required)

Email Address(required)

Please tick the blocks below, which are applicable to you:

I will register to vote in the 2016 Municipal Election

Yes

This is my first time to vote

Yes

I moved in to the area recently

Yes

I need help to be picked up for registration

Yes

Where must I go to register to vote? Please call me

Yes

Please send me a reminder

Yes

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