Your vote in 2011 will help give Democrats a voice in Virginia and stop one-party, Republican rule.

star Fill out the form below to get started  star

Required information = *

For assistance, please contact the the Democratic Party of Virginia at 1-800-322-1144.

Legal Name





*

Previous Legal Name


*



Contact Information




(Example:8047800111)


(Example:8047800111)

Voter Record Identification Information




(Example: 1962)


(Example: 1234). We will not store or save the last four digits of your SS#. If you prefer, you can simply fill it in on the copy we email you, but please note that failure to include your SSN on the form you mail in may result in your Absentee Ballot Request being rejected.

Reason For Requesting An Absentee Ballot *


Deliver Ballot To *

Voter Registration Address






New Virginia Residence (Permanent) Home Address





Mailing Address if different from New Virginia Residence Address
(If Rural Address or if you are a Protected Voter)





Old Virginia Residence (Permanent) Home Address







(Example: MM/DD/YYYY)

Alternate Address







Ballot Assistance *

Voter Assistance Statement

Voter Assistant Legal Name




Voter Assistant Address






Please be patient as this process can take a few seconds to complete.

Your friends and neighbors are counting on you to vote in 2011

If there is any chance that you might not be able to make it to the polls on November 8, 2011, you are allowed to vote by mail in Virginia. Just fill out the form above and an application will be generated for you. Virginia Law requires a reason for voting absentee. You need to fill in all of the boxes that are starred (*). Once you have completed the form, click the download button above. Within a few minutes you will receive your personalized Absentee Ballot Request Form.

You must print this form, fill in the red boxes on the form and then mail or fax it to your local Voter Registrar's office. Please note, completing this online form does not automatically send in an Absentee Ballot Request form. You must print it off, sign it, date it, fill in the sections in red, and then mail or fax it to the address listed in the email. This Absentee Ballot Request Form must be returned to your local Registrar's Office by 5pm on Tuesday, November 1, 2011.

Once you mail or fax the completed Absentee Ballot Request Form into your Registrar's office, they will mail you the ballot. Then, vote for the Democrats and mail your ballot in by Tuesday November 8th, or you can deliver by hand to your local registrar. If you have any questions, please call 800-322-1144.

Paid for and authorized by the Democratic Party of Virginia