INSIGHT Citizen's Academy Registration

4. First Name*

5. Last Name*

7. Mailing Address

9. City*

10. State*

11. Zip Code*

13. Phone Number*

14. Email*

16. Knowlege Base*

    1. very low
    2. low

    1. average
    2. high

    1. very high

    How would you rate your current knowlege of the City of Farmington's services, operations, and procedures?

18. Signature*

    “I hearby give my permission for the City of Farmington to use any still photograph in which I may appear for whatever purpose(s) deemed appropriate.”

19. Date*

21. Notes:
    Registration forms are accepted first‐come, first‐served. The program will be cancelled if the minimum number of participants is not met

    Registration forms are accepted first‐come, first‐served. The program will be cancelled if the minimum number of participants is not met

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field