PTV Registration
Please complete the registration form below. After submitting, a confirmation email will be sent to the email address provided. If you do not receive it withing a few minutes, please check your spam or junk folder.
School Name
*
Name of Contact
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Grade(s)
*
Number of Students
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like a Mississippi Secretary of State's Office representative to visit your school to promote the program or assist with the mock election?
*
Yes
No
How did you hear about us?
*
Internet
Colleague/Friend
SOS Event
TV/Radio/News
Other
Additional Comments or Questions
Register
Should be Empty: