Voteworks: Partner Initative: Working Assets

Online Voter Registration Web Site Application

Company & Contact Information

Company/Organization
Contact Person
Email	Note: This will only be used to contact you about this form.
Phone
Fax
Address
City
State
Zip Code
Web Site Url

Which non-profit voter registration group would you like to suppport with any funds raised via your participation in the Working Assets nonpartisan online voter registration program?

National Voice/Voteworks
NAACP National Voter Fund
Project Vote
US Action Education Fund
Public Interest Research Group (PIRG)
United States Students Association

On what type of web site will the voter registration take place?

Internal (Intranet/Extranet)
External (Customer)
Both

>Any questions? Email us at info@voteworks.org. Company logos may also be mailed to that address.