Collierville Police National Night Out Registration

Please provide the following information about your group's activities for National Night Out

Name of Group

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Type of Group

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Date of Event (Select from calendar below)


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Times of Event

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Exact Location of Event

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Approximate attendance expected

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Please provide your personal information below.

Name

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Address

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Phone

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Email

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After submitting this form, you should receive an email listing the information you provided.

Please type in what you see (*)

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