2. First Name
3. Last Name
5. E-mail
6. Phone
8. Address1
10. City
11. State
12. Zip
14. Please specify what you would like to do:

    Describe your general plan for both the event and for how you propose to use grant funds. A separate budget may be submitted.

16. What exact street/HOA/section will this event take place on?

    For example, Victoria Heights OR Longleaf OR Maycheck Lane

18. Specify what date you had in mind:
    Specify what date you had in mind:

    Specify what date you had in mind:
20. Check all that apply

    1. Need staff assistance coming up with an idea
    2. Need help formulating budget
    3. Would like invitations sent out to Councilmember
    4. Are doing a "green" activity
22. Agree to submit all receipts?

    1. Yes
    2. No

    We ask for receipt submittal for staff review of purchases before remittance of payment to event coordinator.

24. Thank you! We will contact you shortly!
Leave This Blank:


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

    This field is not part of the form submission.

27. Submit

* indicates a required field