<form-template> <fields> <field type="text" subtype="text" required="true" label="Name" description="Please enter your name as it is listed on your driver's license, Manitoba Enhanced Identification Card, and/or other official government documents." placeholder="Please enter your name as it is listed on your driver's license, Manitoba Enhanced Identification Card, and/or other official government documents." class="form-control text-input" name="text-1657220203819"></field> <field type="date" required="true" label="Date of Birth" class="form-control calendar" name="date-1657220235547"></field> <field type="text" subtype="text" required="true" label="Phone Number" description="We may need to contact you to confirm details of your registration. Please provide a phone number that you can be reached at." placeholder="We may need to contact you to confirm details of your registration. Please provide a phone number that you can be reached at." class="form-control text-input" name="text-1657220255257"></field> <field type="header" subtype="h3" label="MAILING ADDRESS" class="header"></field> <field type="text" subtype="text" required="true" label="Street Address" class="form-control text-input" name="text-1657220294466"></field> <field type="text" subtype="text" label="Address Line 2" class="form-control text-input" name="text-1657220315242"></field> <field type="text" subtype="text" required="true" label="City" class="form-control text-input" name="text-1657220371555" value="Altona"></field> <field type="select" label="Provine" class="form-control select" name="select-1657220430955"> <option value="Manitoba" selected="true">Manitoba</option> <option value="Alberta">Alberta</option> <option value="British Columbia">British Columbia</option> <option value="New Brunswick">New Brunswick</option> <option value="Newfoundland and Labrador">Newfoundland and Labrador</option> <option value="Nova Scotia">Nova Scotia</option> <option value="Ontario">Ontario</option> <option value="Prince Edward Island">Prince Edward Island</option> <option value="Quebec">Quebec</option> <option value=" Saskatchewan"> Saskatchewan</option> <option value="Northwest Territories">Northwest Territories</option> <option value="Nunavut">Nunavut</option> <option value="Yukon">Yukon</option> </field> <field type="text" subtype="text" required="true" label="Postal Code" placeholder="R0G 0B0" class="form-control text-input" name="text-1657220639834" value="R0G 0B0"></field> <field type="header" subtype="h3" label="Civic Address of Altona Property" class="header"></field> <field type="paragraph" subtype="blockquote" label="In order to be eligible to vote in Altona, you must be a resident of Altona for at least six months prior to the election date, or a registered owner of land in Altona for at least six months prior to the election date. Please enter your civic address." class="paragraph"></field> <field type="text" subtype="text" label="Apartment #" class="form-control text-input" name="text-1657220747113"></field> <field type="text" subtype="text" required="true" label="House #" class="form-control text-input" name="text-1657220788711"></field> <field type="text" subtype="text" required="true" label="Street Name, Type, Quadrant" class="form-control text-input" name="text-1657220808695"></field> <field type="header" subtype="h3" label="Voter Eligibility Declaration" class="header"></field> <field type="paragraph" subtype="blockquote" label="By submitting this form, I declare that as of October 26, 2022, I am:" class="paragraph"></field> <field type="checkbox-group" required="true" class="checkbox-group" name="checkbox-group-1657220938914"> <option value="at least 18 years old" selected="true">at least 18 years old</option> <option value=" a Canadian citizen"> a Canadian citizen</option> <option value="a resident of Altona for at least six months OR a registered owner of land in Altona for at least six months">a resident of Altona for at least six months OR a registered owner of land in Altona for at least six months</option> </field> </fields> </form-template> Submit Submitting...