Voter Registration Campaign_2 Testing formCheck your Voter Registration  New Registration / Change of AddressVolunteer DetailsFirst NameLast NameCell phone numberEmailDate / TimeLocation DetailsZoneZoneZone 1Zone 2Zone 3Zone 4Zone 5Zone 6Zone 7Zone 8Zone 9Zone 10Zone 11Zone 12Zone 13Zone 14Zone 15Zone 16WardWardVoting DistrictVoting DistrictVoter Details (Individual)First NameLast NameID NumberCell Phone NumberEmailAge Group- Select -16-2526-3536-5960+Gender- Select -MaleFemaleVoter Address DetailsAddress:Voter Registration StatusAre You Registered To Vote?- Select -New RegistrationChange of AddressCheckingVote ANC Campaign1. Voting Preference--- Select ---Vote ANCUndecidedHostile2. Follow-Up Required- Select -YesNo3. If Yes, assign to:- Select -Ward CouncilorBranch Executive Committee (BEC)VD CoordinatorBET CoordinatorZET CoordinatorRegional Executive CommitteeService Delivery Team4. Reason for Follow-up- Select -Voter requested another visitVoter undecidedService delivery complaintRegistration assistance requiredSpecial Vote assistanceTransport required on voting dayOther Special Voter Eligibility- Select -Elderly(60+)Person with DissabilityTemporarily Disabled/InjuredPregnantEssential Worker(Unavailable on Voting Day)Other(Specify)Type of Special Vote Required- Select -Home VisitVoting StationNot SureTransport Support? Will you require transport on voting day? (Yes or No)- Select -YesNoIf Yes:Preferred Voting TimeEarly Morning (07h00-10h00)Midday(10h00-14h00)Late Afternoon (14h00-19h00)Community IssuesCheckbox Field Water Electricity Billing Roads Housing Crime Unemployment Other I have read and agree to the POPI Act and Privacy PolicySubmit Form
