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Middletown Ride to the Polls
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What is your first and last name?
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Your answer
Please provide the telephone number where you can be reached on Election Day.
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Your answer
Please provide the address you would like to be picked up from on Election Day.
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Your answer
Please provide a preferred pick up time. (While every effort will be made to accommodate all requests but
availability may vary based on our volunteer drivers and campaign staff)
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