Registration
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone
Format: (000) 000-0000.
Please check the designation you feel best represents you
*
Individual Community Member
Montgomery College Student
Montgomery College Faculty
Montgomery County Staff
Other/Community Group (please share below)
If you chose "Other" as your designation above, please tell us your designation or community group.
How did you hear about the Community-Informed Policing Community Dialogue
*
Social Media
Word of Mouth
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Other
If you chose "Other" as your designation above, please tell us how you heard about the community dialogue.
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