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Election Protection – Attorney Volunteer Form
First Name
*
Last Name
*
Street Address
*
Apt. #
City
*
State
*
ZIP
*
Home Phone
Cell Phone
Email Address
*
Occupation
*
Do you have experience with "Protect the Vote"?
*
Yes
No
Are you bilingual? If so, list languages:
AVAILABILITY
I am most interested in volunteering for:
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Regional Director
Mobile Legal Volunteer
Rapid Response Network
Expert Panel
Preferred Region for Regional Director
*
Delta Region - Tunica, Coahoma, Quitman, Bolivar, Tallahatchie, Yalobusha, Grenada, Leflore, Sunflower, Washington, Humphreys, Holmes, Sharkey, Issaquena, Carroll, Montgomery
Northern Region - DeSoto, Tate, Panola, Lafayette, Marshall, Benton, Tippah, Union, Pontotoc, Alcorn, Prentiss, Lee, Tishomingo, Itawamba
Northeast Region - Calhoun, Chickasaw, Monroe, Webster, Clay, Choctaw, Oktibbeha, Lowndes, Winston
Central West Region - Attala, Yazoo, Madison, Leake, Warren, Hinds, Claiborne, Copiah, Jefferson
Central East Region - Noxubee, Neshoba, Kemper, Rankin, Scott, Newton, Lauderdale, Simpson, Smith, Jasper, Clarke
Southwest Region - Adams, Franklin, Lincoln, Lawrence, Jefferson Davis, Wilkinson, Amite, Pike, Walthall
Southern Region - Covington, Jones, Wayne, Marion, Lamar, Forrest, Perry, Greene, Pearl River, Stone, George, Hancock, Harrison, Jackson
Preferred Region for Mobile Legal Volunteer
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Delta Region - Tunica, Coahoma, Quitman, Bolivar, Tallahatchie, Yalobusha, Grenada, Leflore, Sunflower, Washington, Humphreys, Holmes, Sharkey, Issaquena, Carroll, Montgomery
Northern Region - DeSoto, Tate, Panola, Lafayette, Marshall, Benton, Tippah, Union, Pontotoc, Alcorn, Prentiss, Lee, Tishomingo, Itawamba
Northeast Region - Calhoun, Chickasaw, Monroe, Webster, Clay, Choctaw, Oktibbeha, Lowndes, Winston
Central West Region - Attala, Yazoo, Madison, Leake, Warren, Hinds, Claiborne, Copiah, Jefferson
Central East Region - Noxubee, Neshoba, Kemper, Rankin, Scott, Newton, Lauderdale, Simpson, Smith, Jasper, Clarke
Southwest Region - Adams, Franklin, Lincoln, Lawrence, Jefferson Davis, Wilkinson, Amite, Pike, Walthall
Southern Region - Covington, Jones, Wayne, Marion, Lamar, Forrest, Perry, Greene, Pearl River, Stone, George, Hancock, Harrison, Jackson
Preferred Region for Rapid Response Network
*
Delta Region - Tunica, Coahoma, Quitman, Bolivar, Tallahatchie, Yalobusha, Grenada, Leflore, Sunflower, Washington, Humphreys, Holmes, Sharkey, Issaquena, Carroll, Montgomery
Northern Region - DeSoto, Tate, Panola, Lafayette, Marshall, Benton, Tippah, Union, Pontotoc, Alcorn, Prentiss, Lee, Tishomingo, Itawamba
Northeast Region - Calhoun, Chickasaw, Monroe, Webster, Clay, Choctaw, Oktibbeha, Lowndes, Winston
Central West Region - Attala, Yazoo, Madison, Leake, Warren, Hinds, Claiborne, Copiah, Jefferson
Central East Region - Noxubee, Neshoba, Kemper, Rankin, Scott, Newton, Lauderdale, Simpson, Smith, Jasper, Clarke
Southwest Region - Adams, Franklin, Lincoln, Lawrence, Jefferson Davis, Wilkinson, Amite, Pike, Walthall
Southern Region - Covington, Jones, Wayne, Marion, Lamar, Forrest, Perry, Greene, Pearl River, Stone, George, Hancock, Harrison, Jackson
Availability
*
7:00 AM to 10:00 AM
10:00 AM to 1:00 PM
1:00 PM to 4:00 PM
4:00 PM to 7:00 PM
All Day
Person to Notify in Case of Emergency
Name
*
First
Last
Phone
*
Future Contact
Use the checkboxes below to select the kinds of emails (if any) you would like to receive from us.
Event/Training Schedules
Twitter Townhalls
Reminders
Newsletters
I warrant and represent that I am participating in this nonpartisan project to improve the election process, promote voter enfranchisement, and ensure that every vote counts as intended by the voters. I will not disrupt the election process or interfere in any way with the legal duties of poll workers and election officials. I understand the Protect the Vote Program is a nonpartisan effort and agree that during my volunteer shift I will not elicit or convey to any person seeking assistance any partisan information. I have read, understand, and agree to the Protect the Vote privacy policy described herein. To the extent the information disclosed to me by a caller to the hotline or by personnel working for the Protect the Vote Program is confidential or private in nature, I will not disclose such information without prior written authorization. Additionally, in the event that any confidential information or material relating to the entity(ies) hosting and supporting Protect the Vote Program activities is disclosed to me, whether or not such disclosure is voluntary or accidental, I shall not make any further disclosure of any such information or material. I shall keep confidential and follow established election incident reporting system procedures for handling of certain information, such as personally-identifiable information about callers who report election incidents. I will not redistribute private emails or other private communications without prior written permission from the person(s) whose private information would be disclosed by my actions. I will not knowingly engage in illegal distribution practices when posting information on election incident reporting. I shall release, defend, hold harmless and indemnify the MS State Conference NAACP and its officers, directors, employees and assigns, and other entities hosting or supporting Protect the Vote Program activities, and their partners, members, employees and assigns, from and against any and all claims, demands, causes of action, losses, damages, liabilities, costs and expenses, including reasonable attorneys’ fees and costs, arising out of, resulting from or pertaining to any violation by me of this Code of Conduct; or any negligent or wrongful act or omission by me. I understand that any violation of this Code of Conduct may result in termination of my volunteer status and may have other negative consequences.
*
By checking this box, I indicate my agreement with the above Code of Conduct
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