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2. 
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Daytime Phone Number
14. Daytime Phone Number
16. Any specific comments regarding the entry
18. I would rather be notified by

    1. Phone
    2. Email
20. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Electronic Applicant Signature
24. Date
    Date
26. Notice of Filming and Photography
    By attending a City of North Miami event, you are entering an area where photography, audio, and video recording may occur. By agreeing to these terms, you consent to photography, audio recording, video recording and its release, publication, exhibition, or reproduction to be used for promotional purposes, advertising, inclusion on websites, social media, or any other purpose by the City of North Miami and its representatives.
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field