Before beginning, please provide us with an e-mail address so we can send you the results of the survey:

E-mail address: (required)

1)  Did you vote in the most recent election?             Yes    No

2) Please type the location of the polling place in the box below:
Type of building (ie School, Firehouse, etc): Address: City:

3)  Did you experience any accessibility problems when you went to vote (e.g.: Parking, entrance to building and/or booth, alternative format ballots, etc)?

        If Yes, then please describe:

        Would you like to be contacted with regard to resolving this issue or matter?