2. Organizer Information
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State
13. Zip*
15. Email Address
17. Phone Number*
    If more than one, separate with a comma
19. Event duration*
    Event duration Start Date

    Event duration Start Time

    —

    Event duration End Date

    Event duration End Time
    Enter event start and end dates and times
    Note: barricades must be removed from public streets by dark
21. Actual location of event*
    Provide details of what areas will be closed
23. Address where to drop barricades*
25. Have all residents in the affected area been advised of this event?*

    1. Yes

    1. No
27. Any additional information
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field