Title is required.
Use your full first name. Do not use nicknames or initials.
This field is required.
optional
You must be a U.S. citizen to register

Previous Name

Title is required.
Use your full first name. Do not use nicknames or initials.
This field is required.
optional
Put your home address in these boxes. Do not put your mailing address here if it is different from your home address. Do not use a post office box or rural route without a box number. If you live in a rural area but do not have a street address, or if you have no address, please show where you live using the map on the printed form.
Not in IN?
Enter a valid 5 digit zip code.
If you receive mail at a different address, please enter it here.
Enter a valid 5 digit zip code.
If you have moved since your last registration, enter your previous address.
Enter a valid 5 digit zip code.
You must provide your ten-digit Indiana driver's license number or Bureau of Motor Vehicles ID number. If you do not have a driver's license or State of Indiana BMV ID card, please enter the last four digits of your Social Security number. Please indicate which number was provided.
Enter your birthdate in MM/DD/YYYY format.
Enter a phone number in xxx-xxx-xxxx format.
Indiana law does not permit a person to indicate their party affiliation, if any, as part of their registration record. You will have to declare your party affiliation prior to voting in a primary election.
The state of Indiana does not request information about your race or ethnicity. However, Rock the Vote would appreciate this information in order to measure the effectiveness of our voter registration efforts. This information will NOT appear on your printed voter registration form.

Survey Questions (optional)

Optional
Optional