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National Night Out Block Registration Form

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Contact Name:
Phone Number:
Email Address
Address:
Block (including cross streets):
EXAMPLE: 100 block of W. 24th Avenue between Flores and Hacienda.
Location of Event:
EXAMPLE: Front yard of apartment building at 100 W. 24th Avenue
Hours of Event:
Hours of Event: Start Time
—
Hours of Event: End Time
Type of Event:
Please describe what you have planned for your gathering.
Is your block currently a Neighborhood Watch block?
PLEASE NOTE: Neighborhood Watch blocks will receive priority for visits by Police staff.
1. YES
1. NO

Leave This Blank:

1. Receive an email copy of this form.
Email address

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National Night Out Block Registration Form