ELECTION POLL
N
ame:
E
mail:
C
ity:
S
tate:
U
S Citizen:
yes
no
G
ender:
male
female
A
ge Group:
18-25
26-30
31-40
41-50
51-60
61+
Y
our Choice:
Please Choose One...
Candidate 1
Candidate 2
Candidate 3