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2. 
4. Participating Neighborhood Group(s):*
6. Address of Event*
8. Time Frame of Event*
10. Contact Person's Name*
12. Contact Person's Phone*
13. Contact Person's Email*
15. We would like a Police Department representative to visit during our event:*

    1. Yes
    2. No

17. Due to staffing levels, it may be necessary to limit the number of sites visited. Requests will be filled on a “first come” basis.

19. We would like elected officials (Police Chief, Mayor, City Council, etc.) to visit our event:*

    1. Yes
    2. No

21. Your party will be added to a list of others that have requested VIP visits. While we will do our best to honor this request, it cannot be guaranteed .

23. We would like members of the local media to stop by for photo opportunities:*

    1. Yes
    2. No

25. If you answer “No” you will be excluded from the party list provided to press. If your party is of a large scale and in a public place, they may still find it.

27. Briefly describe your event plans: *

    (Parties with food and entertainment are always better attended by all involved.)

29. Estimated number of households participating:*
30. Estimated number of people participating:*
31. Number of children under 12 years of age attending:*
33. Questions?

    Contact the Crime Prevention Unit at 510-577-3228.

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field