O S B O R N    C O M M U N I T Y    M E E T I N G Survey

Please complete the following;(Required.)

Name (first and last):

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Are you RSVPing for another adult in your household? If so, please provide the following information:

Name (first and last):

Email Address:

Phone Number:

Are you planning to bring any children (birth-age 18) to the Community Meeting?(Required.)

No

Yes, a young child not requiring his/her own chair

Yes, a child or children age 2 (potty-trained) or older who will participate in children's activities

Yes, a child or children age 2 up to 7th grade who will sit with me during the meeting.

Yes, a child or children 8th grade through high school who will participate in the meeting.

Please specify the number and age of children who will be participating in children's activities (if applicable):

Please list any affiliations (for example, if you are an employee or board member of a church, nonprofit organization, or block club):