Voter Registration Form

Name *

Date of Birth *

Phone Number *

MAILING ADDRESS

Street Address *

Address Line 2

City *

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 26, 2022, 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