Required fields are marked with asterisks (*)

FORM 22 - Request For Special Ballot Package

Local Authorities Election Act (Sections 77.1)

LOCAL JURISDICTION: County of Grande Prairie No. 1, PROVINCE OF ALBERTA

ELECTION DATE: October 20, 2025

Residents unable to vote at an advance voting station or at a voting station on election day are eligible to request a Special Ballot Package.

First Name

Last Name

Contact Phone Number

Contact Email Address

Complete Address Including Postal Code

Please indicate your status on the permanent electors register below

I am properly on the permanent electors register for the above named local jurisdiction.

I am not properly on the permanent electors register for the above named local jurisdiction.

Personal information collected on this form will be used for the purpose of administering the election. This collection is authorized by Section 4(c) of the Protection of Privacy Act and the information collected will also be subject to the Access to Information Act. For questions about this collection of personal information by the County of Grande Prairie (10001-84 Avenue, Clairmont, AB T8X 5B2), contact the Access and Privacy Officer at AccessPrivacy@countygp.ab.ca or call 780-532-9722.