National Night Out Community Resource Registration Form
TUESDAY, AUGUST 4TH 2026 5PM-8PM
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IMPORTANT INFORMATION
IF YOU ARE SIGNING UP TO BE A COMMUNITY RESOURCE VENDOR FOR NATIONAL NIGHT OUT YOU ARE ALSO AGREEING TO BE SCHEDULED FOR THE RAIN OUT DATE SEPTEMBER 8TH, 2026 FROM 5PM-8PM SHOULD WE HAVE TO POSTPONE THE AUGUST 4TH DATE DUE TO THE WEATHER. PLEASE BRING YOUR OWN TABLES AND CHAIRS.
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NAME OF RESOURCE
*
What community need(s) does your organization address?
*
Housing
Food assistance
Youth services
Senior services
Mental health services
Veteran services
Public safety
CONTACT INFORMATION
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Do you agree that approval is at the discretion of the event organizers?
*
Yes
No
Do you agree not to conduct medical procedures, blood draws, injections, vaccinations, or other clinical services without prior written approval from the event organizers?
*
Yes
No
Submit
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