<form-template> <fields> <field type="header" subtype="h3" label="1. APPLICANT INFORMATION/RENSEIGNEMENTS SUR LE DEMANDEUR" class="header"></field> <field type="text" subtype="text" required="true" label="Full Name /Nom complet" class="form-control text-input" name="text-1784756372456"></field> <field type="text" subtype="text" required="true" label="Date of Birth/Date de naissance (MM/DD/YYYY) " class="form-control text-input" name="text-1784756374496"></field> <field type="text" subtype="text" required="true" label="Phone Number/Numéro de téléphone" class="form-control text-input" name="text-1784756437353"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="header" subtype="h3" label="ADDRESS DETAILS/DÉTAILS DE L’ADRESSE*" class="header"></field> <field type="text" subtype="text" required="true" label="Residential Civic Address/Adresse civique résidentielle" class="form-control text-input" name="text-1784756497600"></field> <field type="header" subtype="h1" label=" " class="header"></field> <field type="text" subtype="text" required="true" label="City/Ville" class="form-control text-input" name="text-1784756507561"></field> <field type="text" subtype="text" required="true" label="Postal Code/Code Postal" placeholder="City" class="form-control text-input" name="text-1784756512923"></field> <field type="text" subtype="text" label="Mailing Address (if different from residential address)/Adresse postale (si différente de l'adresse de résidence)" class="form-control text-input" name="text-1784756514851"></field> <field type="header" subtype="h1" label=" " class="header"></field> <field type="text" subtype="text" label="City/Ville" class="form-control text-input" name="text-1784756532371"></field> <field type="text" subtype="text" label="Postal Code/Code Postal" class="form-control text-input" name="text-1784756760461"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="radio-group" required="true" label="Are there any additional people living in your home who are eligible to vote?" class="radio-group" name="radio-group-1784756834230"> <option value="yes" selected="true">Yes</option> <option value="no">No</option> </field> <field type="header" subtype="h1" label=" " class="header"></field> <field type="textarea" label="If you answered YES to the previous question, please indicate the full name(s) and date of birth of all eligible voters below." class="form-control text-area" name="textarea-1784756897343"></field> <field type="checkbox" required="true" label="I declare that the information provided is true and accurate to the best of my knowledge. I understand that election officials may contact me to verify this information and may request government-issued photo identification if required./ Je déclare que les renseignements fournis sont, à ma connaissance, véridiques et exacts. Je comprends que les responsables électoraux peuvent communiquer avec moi pour vérifier ces renseignements et peuvent me demander de présenter une pièce d’identité avec photo émise par le gouvernement, au besoin." class="checkbox" name="checkbox-1784756969201"></field> <field type="date" required="true" label="Date (MM/DD/YYYY) *" class="form-control calendar" name="date-1787749479093"></field> </fields> </form-template> Submit Submitting...
