Neighborhood Block Party Kit Waitlist Form

Thank you for your interest in hosting a Neighborhood Block Party! Please complete all questions below to join the waitlist and receive notification when kits are available.

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* 1. Name / Contact Information:

First Name

Last Name

Organization

Street Address

City

State

Zip Code

Phone Number

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* 2. Identify the county you're located in:

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* 3. Please pick the designation that fits you the best:

Listos California Grant Funded Partner

Local Government Representative

State Government Representative

Local Neighborhood Leader

Local Nonprofit Leader

Other (please specify)

Neighborhood Block Party Kit Waitlist Form

Question Title

* 1. Name / Contact Information:

Question Title

* 2. Identify the county you're located in:

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* 3. Please pick the designation that fits you the best:

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* 4. How many kits would you like to receive? Each kit serves up to 20 Block Party attendees.

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* 5. Any additional comments you'd like to share?