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2. Name*
3. Email Address
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
13. Have you been involved in Community Watch or Neighborhood Watch before?

    1. Yes
    2. No
14. Are you interested in being the Community Watch Captain?

    1. Yes
    2. No
15. Are other neighbors interested in having a Community Watch Meeting in your area?

    1. Yes
    2. No
17. You will be contacted by phone to set up a day and time that will work for you and your neighbors for a meeting.
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field