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
Leave This Blank:


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