Title
Mr.
Mrs.
Ms.
Miss
Dr.
Rev.
First name *
Last name *
Middle name
Suffix
Date Of Birth
Address
City
State
Zip Code
Home Phone
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Registered Voter
Voting District
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District 2
District 3
District 4
District 5
District 6
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District 8
Marital Status
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Gender
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Occupation
Interest(s)
I currently have relatives working for the City of Augusta.
I currently serve on an Augusta Board, Commission, or Authority
I wish to recieve email confirmation of my submission.
Email