Light Up Heath Entry Form

Light Up Heath Entry Form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Entry Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Entry Title
Upload One Entry Photo

Cancelof
Include My Entry on the Light Up Heath Tour Map?
The tour map will be posted on the City website and shared in social media posts. By entering this contest, you provide the City of Heath permission to publish your home photo and entry information.
Should be Empty: