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Registration Application Request

## Voter Registration Application Request

Complete and submit the information below and we will mail you a Voter Registration Application. Nevada law requires that you sign your Voter Registration Application; therefore, we cannot accept applications submitted by e-mail or telephone.

Full Name:


Mailing Address Type:
[x] United States
[x] International

Address:


City:


State:


Zip Code:

If living outside of Clark County, please select the reason:
[x] I am in the military
[x] I am a dependant of a person in the military
[x] I am a Clark County resident temporarily living overseas

Daytime Telephone Number:

(Optional)

E-mail Address:

(Optional)

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