Thank you for registering for Civic Engagement Day on March 22nd, 2018. By providing the following information, you will assist us in making this a very successful day!

* 1. Please enter your first and last name:

* 2. Please enter your permanent/home address:

* 3. I am a member of or affiliated with the following organization(s):

(Check all that apply)

* 4. I am a: (Please check all that apply)

Please note: You will NOT receive a confirmation for registration. You WILL receive an email with details and specifics about Civic Engagement Day the week of March 19, 2018

Thanks for registering!