I pledge to vote.

First Name

Last Name

Cell Phone

State Where I'm Registered to Vote

Are you a member of a URJ congregation?

YesNo

URJ Congregation Name

Congregation ID

I give permission for the RAC to share my pledge(s) with my congregation.

Yes

VOTER PLEDGE

I pledge to vote in the upcoming election.I pledge to help turn out my friends and family to vote.

VOTER PLAN

I will be voting at

polling place/voting by mail

date and time

I will get there by

transportation/voting by mail

Yes, I would like to receive email communications about the Civic Engagement Campaign.

Yes