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

Name (first and last): *

Address:

Address 2:

City/Town:

State:

ZIP: *

Email Address: *

Phone Number: *

Name (first and last):

Email Address:

Phone Number:

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):

Parent or Primary Caregiver

Youth

Resident

Senior

Member of the Osborn Neighborhood Alliance Board

Educator

Youth Development Professional

Safety Professional

Member of the Osborn Business Association

Representative of a Faith-Based Institution

Community Block Club Member

Volunteer

Other

If other, please specify: