Voter Registration Form

Name*
Please enter your name as it is listed on your driver's license, Manitoba Enhanced Identification Card, and/or other official government documents.
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone Number*
We may need to contact you to confirm details of your registration. Please provide a phone number that you can be reached at.
Mailing Address*
Street Address Address Line 2 City Province Postal Code
Civic Address of Altona Property*
In order to be eligible to vote in Altona, you must be a resident of Altona for at least six months prior to the election date, or a registered owner of land in Altona for at least six months prior to the election date. Please enter your civic address.
Apartment # House # Street Name, Type, Quadrant
Voter Eligibility Declaration*
By submitting this form, I declare that as of October 14, 2020, I am:
- at least 18 years old
- a Canadian citizen
- a resident of Altona for at least six months OR a registered owner of land in Altona for at least six months
Email
This field is for validation purposes and should be left unchanged.

Apartment #	House #	Street Name, Type, Quadrant