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 WV?
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 driver's license or non-driver ID number. If you do not have a driver's license or non-driver ID number, then you must provide the last four digits of your Social Security number. If you do not have a driver's license or a Social Security number, please enter "NONE" and the state will assign you an identification number for the purposes of voting.
Enter your birthdate in MM/DD/YYYY format.
Enter a phone number in xxx-xxx-xxxx format.
You must register with a party if you want to take part in that party's primary election, caucus, or convention (unless you request the ballot of a party which allows independents to vote).
The state of West Virginia 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