Municipality of North Cypress-Langford

VOTER REGISTRATION

Please email a picture of your driver's license or government-issued ID following this application to admin@myncl.ca

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		<field type="text" subtype="text" required="true" label="Full Name (Enter your name as it appears on your driver's licence or government issued ID)" class="form-control text-input" name="text-1776700811770"></field>
		<field type="date" required="true" label="Date of Birth" class="form-control calendar" name="date-1776701095582"></field>
		<field type="text" subtype="text" required="true" label="Phone Number (We may need to contact you to confirm details of your registration)" placeholder="204-123-4567" class="form-control text-input" name="text-1776701148588"></field>
		<field type="text" subtype="text" required="true" label="Mailing Address" placeholder="Address Line 1" class="form-control text-input" name="text-1776702825855"></field>
		<field type="text" subtype="text" placeholder="Town, City" class="form-control text-input" name="text-1776703315246"></field>
		<field type="select" placeholder="Province" class="form-control select" name="select-1776703431720">
			<option>Alberta</option>
			<option>British Columbia</option>
			<option>Manitoba</option>
			<option>New Brunswick</option>
			<option>Newfoundland &amp; Labrador</option>
			<option>Northwest Territories</option>
			<option>Nova Scotia</option>
			<option>Nunavut</option>
			<option>Ontario</option>
			<option>Prince Edward Island</option>
			<option>Quebec</option>
			<option>Saskatchewan</option>
			<option>Yukon</option>
			<option>Alabama</option>
			<option>Alaska</option>
			<option>Arizona</option>
			<option>Arkansas</option>
			<option>California</option>
			<option>Colorado</option>
			<option>Connecticut</option>
			<option>Delaware</option>
			<option>District of Columbia</option>
			<option>Florida</option>
			<option>Georgia</option>
			<option>Hawaii</option>
			<option>Idaho</option>
			<option>Illinois</option>
			<option>Indiana</option>
			<option>Iowa</option>
			<option>Kansas</option>
			<option>Kentucky</option>
			<option>Louisiana</option>
			<option>Maine</option>
			<option>Maryland</option>
			<option selected="true">Massachusetts</option>
			<option>Michigan</option>
			<option>Minnesota</option>
			<option>Mississippi</option>
			<option>Missouri</option>
			<option>Montana</option>
			<option>Nebraska</option>
			<option>Nevada</option>
			<option>New Hampshire</option>
			<option>New Jersey</option>
			<option>New Mexico</option>
			<option>New York</option>
			<option>North Carolina</option>
			<option>North Dakota</option>
			<option>Ohio</option>
			<option>Oklahoma</option>
			<option>Oregon</option>
			<option>Pennsylvania</option>
			<option>Rhode Island</option>
			<option>South Carolina</option>
			<option>South Dakota</option>
			<option>Tennessee</option>
			<option>Texas</option>
			<option>Utah</option>
			<option>Vermont</option>
			<option>Virginia</option>
			<option>Washington</option>
			<option>West Virginia</option>
			<option>Wisconsin</option>
			<option>Wyoming</option>
		</field>
		<field type="text" subtype="text" placeholder="Postal Code" class="form-control text-input" name="text-1776712236886"></field>
		<field type="text" subtype="text" required="true" label="Rural Address" placeholder="Part, Section, Township, Range, Meridian" class="form-control text-input" name="text-1776712312042"></field>
		<field type="text" subtype="text" required="true" label="Civic Address" placeholder="Yard Marker, Road Name" class="form-control text-input" name="text-1776712448482"></field>
		<field type="checkbox-group" required="true" label="Voter Eligibility Declaration By submitting this form, I declare that as of October 28, 2026, I am:" class="checkbox-group" name="checkbox-group-1776712680769">
			<option>18 years of age</option>
			<option>a Canadian citizen</option>
			<option>a resident of the Mun of NCL for at least six months OR a registered owner of land in the Mun of NCL for at least six months</option>
		</field>
	</fields>
</form-template>

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