C O D Y R O U G E C O M M U N I T Y M E E T I N G Question Title * Please complete the following; Name (first and last): * Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * Are you RSVPing for another adult in your household? If so, please provide the following information: Name (first and last): Email Address: Phone Number: Question Title * Are you planning to bring any children (birth-age 18) to the Community Meeting? 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): Question Title * Please list any affiliations (for example, if you are an employee or board member of a church, nonprofit organization, or block club): Question Title * What is your role in the Cody Rouge community? Please select all that apply. Parent or Primary Caregiver Youth Resident Senior Member of the Cody Rouge Community Action Alliance Educator Youth Development Professional Safety Professional Member of the Cody Rouge Business Community Representative of a Faith-Based Institution Community Block Club Member Volunteer Other If other, please specify: Next