Mobile Voter Outreach Van Request Form
Pinal County’s Mobile Voter Outreach van is the first-of-its-kind in Arizona. It will help reach voters in rural parts of the county. To request the Voter Van at an event fill out the form below. Please allow 2-3 business days to receive a response.

Calendar of Scheduled Events: bit.ly/3fE56xK

𝘓𝘱 đ˜€đ˜ąđ˜źđ˜Șđ˜°đ˜Żđ˜Šđ˜”đ˜ą đ˜„đ˜Š đ˜đ˜°đ˜”đ˜ąđ˜Żđ˜”đ˜Šđ˜Ž đ˜„đ˜Šđ˜­ đ˜Šđ˜°đ˜Żđ˜„đ˜ąđ˜„đ˜° đ˜„đ˜Š 𝘗đ˜Ș𝘯𝘱𝘭 𝘩𝘮 𝘭𝘱 đ˜±đ˜łđ˜Ș𝘼𝘩𝘳𝘱 đ˜„đ˜Š đ˜Žđ˜¶ đ˜”đ˜Șđ˜±đ˜° 𝘩𝘯 𝘈𝘳đ˜Șđ˜»đ˜°đ˜Żđ˜ą. 𝘈đ˜șđ˜¶đ˜„đ˜ąđ˜łĂĄ 𝘱 𝘭𝘭𝘩𝘹𝘱𝘳 𝘱 𝘭𝘰𝘮 đ˜·đ˜°đ˜”đ˜ąđ˜Żđ˜”đ˜Šđ˜Ž 𝘩𝘯 𝘭𝘱𝘮 đ˜»đ˜°đ˜Żđ˜ąđ˜Ž đ˜łđ˜¶đ˜łđ˜ąđ˜­đ˜Šđ˜Ž đ˜„đ˜Šđ˜­ đ˜€đ˜°đ˜Żđ˜„đ˜ąđ˜„đ˜°. 𝘗𝘱𝘳𝘱 𝘮𝘰𝘭đ˜Șđ˜€đ˜Șđ˜”đ˜ąđ˜ł đ˜€đ˜°đ˜źđ˜±đ˜­đ˜Šđ˜”đ˜Š 𝘩𝘭 đ˜§đ˜°đ˜łđ˜źđ˜¶đ˜­đ˜ąđ˜łđ˜Ș𝘰 𝘱 đ˜€đ˜°đ˜Żđ˜”đ˜Șđ˜Żđ˜¶đ˜ąđ˜€đ˜Șó𝘯. đ˜Œđ˜Žđ˜±đ˜Šđ˜łđ˜Š đ˜Šđ˜Żđ˜”đ˜łđ˜Š 2 đ˜ș 3 đ˜„Ă­đ˜ąđ˜Ž đ˜©ĂĄđ˜Łđ˜Ș𝘭𝘩𝘮 đ˜±đ˜ąđ˜łđ˜ą đ˜łđ˜Šđ˜€đ˜Ș𝘣đ˜Ș𝘳 đ˜¶đ˜Żđ˜ą đ˜łđ˜Šđ˜Žđ˜±đ˜¶đ˜Šđ˜Žđ˜”đ˜ą.

đ˜Šđ˜ąđ˜­đ˜Šđ˜Żđ˜„đ˜ąđ˜łđ˜Ș𝘰 đ˜„đ˜Š đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜°đ˜Ž đ˜±đ˜łđ˜°đ˜šđ˜łđ˜ąđ˜źđ˜ąđ˜„đ˜°đ˜Ž: bit.ly/3fE56xK
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Email *
Mobile Voter Outreach Van
Full name *
Nombre completo
Phone Number *
NĂșmero de telĂ©fono
Name of Event
Nombre del evento
Description/purpose of event
DescripciĂłn / propĂłsito del evento
Address of Event *
DirecciĂłn del evento
Give us a designation of where you will have the van park.(26 ft long / 8 ft wide / 10 ft 8 in tall) *
Danos una designaciĂłn de dĂłnde tendrĂĄs el estacionamiento del van (26 pies de largo / 8 pies de ancho / 10 pies 8 pulgadas de alto)
Name of Organization
Nombre de la organizaciĂłn
Date Requesting the Van (*Contingent upon availability*) *
Fecha de solicitud (* Sujeto a disponibilidad *)
MM
/
DD
/
YYYY
Time you would like us to arrive *
Hora a la que desea que lleguemos
Time
:
Time the van is no longer needed *
Hora en que ya no se necesita la camioneta
Time
:
How many hours needed? *
ÂżCuĂĄntas horas necesitas?
If needed for longer than 3 hours, please explain why/how the van being at this event for a longer period will benefit the event/community/Pinal County residents.
Si es necesario por mås de 3 horas, explique por qué / cómo la camioneta que participa en este evento por un período mås largo beneficiarå al evento / comunidad / residentes del Condado de Pinal.
What Voter Outreach activities are you requesting? *
¿Qué actividades de extensión electoral estå solicitando?
Required
Will we be required to fill out Application and/or pay a Fee for this event? *
ÂżSe nos pedirĂĄ que complete la solicitud y / o pague una tarifa por este evento?
Will we require a special permit to be in the location of the event? *
ÂżRequeriremos un permiso especial para estar en el lugar del evento?
Is this event public & non-partisan? *
ÂżEs este evento pĂșblico y no partidista?
Is there electrical hook-up available?
¿Hay conexión eléctrica disponible?
Clear selection
Will restrooms be accessible for our staff? *
Comments or Questions
Comentarios o preguntas
Request Agreement / đ™Žđ™€đ™Ąđ™žđ™˜đ™žđ™©đ™–đ™§ 𝙖𝙘đ™Șđ™šđ™§đ™™đ™€
*Please note that filling out this form does not confirm the Mobile Voter Outreach Van will be at your event, our attendance at your event is contingent on availability and/or compatibility of event purpose/goal. The Mobile Voter Outreach Van needs to follow polling place guidelines & procedures. Pinal County has the right to refuse attendance and cancel events*

*Due to the COVID-19 pandemic we may not be able to accommodate all events and hours of availability may be restricted*

* 𝘛𝘩𝘯𝘹𝘱 𝘩𝘯 đ˜€đ˜¶đ˜Šđ˜Żđ˜”đ˜ą đ˜Čđ˜¶đ˜Š đ˜€đ˜°đ˜źđ˜±đ˜­đ˜Šđ˜”đ˜ąđ˜ł đ˜Šđ˜Žđ˜”đ˜Š đ˜§đ˜°đ˜łđ˜źđ˜¶đ˜­đ˜ąđ˜łđ˜Ș𝘰 𝘯𝘰 đ˜€đ˜°đ˜Żđ˜§đ˜Ș𝘳𝘼𝘱 đ˜Čđ˜¶đ˜Š 𝘭𝘱 đ˜€đ˜ąđ˜źđ˜Șđ˜°đ˜Żđ˜Šđ˜”đ˜ą đ˜„đ˜Š đ˜đ˜°đ˜”đ˜ąđ˜Żđ˜”đ˜Šđ˜Ž đ˜„đ˜Šđ˜­ đ˜Šđ˜°đ˜Żđ˜„đ˜ąđ˜„đ˜° đ˜„đ˜Š 𝘗đ˜Ș𝘯𝘱𝘭 đ˜Šđ˜Žđ˜”đ˜ąđ˜łĂĄ 𝘩𝘯 đ˜Žđ˜¶ đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜°, đ˜Żđ˜¶đ˜Šđ˜Žđ˜”đ˜łđ˜ą 𝘱𝘮đ˜Șđ˜Žđ˜”đ˜Šđ˜Żđ˜€đ˜Ș𝘱 𝘱 đ˜Žđ˜¶ đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜° đ˜„đ˜Šđ˜±đ˜Šđ˜Żđ˜„đ˜Š đ˜„đ˜Š 𝘭𝘱 đ˜„đ˜Șđ˜Žđ˜±đ˜°đ˜Żđ˜Ș𝘣đ˜Ș𝘭đ˜Șđ˜„đ˜ąđ˜„ đ˜ș / 𝘰 đ˜€đ˜°đ˜źđ˜±đ˜ąđ˜”đ˜Ș𝘣đ˜Ș𝘭đ˜Șđ˜„đ˜ąđ˜„ đ˜„đ˜Šđ˜­ đ˜±đ˜łđ˜°đ˜±Ăłđ˜Žđ˜Șđ˜”đ˜° / đ˜°đ˜Łđ˜«đ˜Šđ˜”đ˜Șđ˜·đ˜° đ˜„đ˜Šđ˜­ đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜°. 𝘓𝘱 đ˜€đ˜ąđ˜źđ˜Șđ˜°đ˜Żđ˜Šđ˜”đ˜ą đ˜„đ˜Šđ˜Łđ˜Š đ˜Žđ˜Šđ˜šđ˜¶đ˜Ș𝘳 𝘭𝘱𝘮 đ˜±đ˜ąđ˜¶đ˜”đ˜ąđ˜Ž đ˜ș 𝘭𝘰𝘮 đ˜±đ˜łđ˜°đ˜€đ˜Šđ˜„đ˜Ș𝘼đ˜Șđ˜Šđ˜Żđ˜”đ˜°đ˜Ž đ˜„đ˜Šđ˜­ đ˜­đ˜¶đ˜šđ˜ąđ˜ł đ˜„đ˜Š đ˜·đ˜°đ˜”đ˜ąđ˜€đ˜Șó𝘯. 𝘌𝘭 đ˜€đ˜°đ˜Żđ˜„đ˜ąđ˜„đ˜° đ˜„đ˜Š 𝘗đ˜Ș𝘯𝘱𝘭 đ˜”đ˜Ș𝘩𝘯𝘩 đ˜„đ˜Šđ˜łđ˜Šđ˜€đ˜©đ˜° 𝘱 đ˜łđ˜Šđ˜€đ˜©đ˜ąđ˜»đ˜ąđ˜ł 𝘭𝘱 𝘱𝘮đ˜Șđ˜Žđ˜”đ˜Šđ˜Żđ˜€đ˜Ș𝘱 đ˜ș đ˜€đ˜ąđ˜Żđ˜€đ˜Šđ˜­đ˜ąđ˜ł 𝘩𝘭 đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜°.*

* 𝘋𝘩𝘣đ˜Șđ˜„đ˜° 𝘱 𝘭𝘱 đ˜±đ˜ąđ˜Żđ˜„đ˜Šđ˜źđ˜Ș𝘱 đ˜„đ˜Š 𝘊𝘖𝘝𝘐𝘋-19, 𝘩𝘮 đ˜±đ˜°đ˜Žđ˜Ș𝘣𝘭𝘩 đ˜Čđ˜¶đ˜Š 𝘯𝘰 đ˜±đ˜°đ˜„đ˜ąđ˜źđ˜°đ˜Ž đ˜ąđ˜€đ˜°đ˜źđ˜°đ˜„đ˜ąđ˜ł đ˜”đ˜°đ˜„đ˜°đ˜Ž 𝘭𝘰𝘮 đ˜Šđ˜·đ˜Šđ˜Żđ˜”đ˜°đ˜Ž *
I have read and understand the Request Agreement / 𝘏𝘩 đ˜­đ˜ŠĂ­đ˜„đ˜° đ˜ș đ˜Šđ˜Żđ˜”đ˜Șđ˜Šđ˜Żđ˜„đ˜° 𝘩𝘭 đ˜ˆđ˜€đ˜¶đ˜Šđ˜łđ˜„đ˜° đ˜„đ˜Š 𝘮𝘰𝘭đ˜Șđ˜€đ˜Șđ˜”đ˜¶đ˜„ *
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