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* 1. Please enter your first name.

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* 2. Please enter your last name.

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* 4. Please enter the municipality you represent (enter "n/a" if you are from the county).

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* 5. What is your role within your jurisdiction?

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* 6. Beyond the baseline requirements, the Wisconsin Elections Commission may would like to know the election security needs of local jurisdictions. From the list below, please indicate which options your jurisdiction is interested in implementing.

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* 7. Please provide any additional comments or concerns regarding election security including ideas, special situations, or questions you would like staff feedback on in the space below.

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* 8. Please provide the email and phone number to reach you at for follow up questions.

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