CITIZEN'S ACADEMY REGISTRATION

First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
Zip:
Phone Number:
Email Address:
Employer/Business Name:
Street Address:
City:
State:
Zip:
Phone Number:
Organizations with which you are involved:
Why do you wish to attend the Citizen's Academy?
How did you hear about the Citizen's Academy?




NOTE -- The Citizen's Academy is held once a month from 8:00 a.m. until 4:00 p.m.