City of Nampa Form Center

2. First Name*
3. Last Name*
4. Organization (if applicable)
6. Address1*
8. Address2
10. City*
11. State*
12. Zip*
14. E-Mail*
15. Phone*
17. Do you live in Nampa city limits?*
    -- Select One --YesNoNot sure
18. Will you be able to attend all of the weekly sessions for the Citizen's Academy? *
    -- Select One --YesNot all, but mostI'm not sure
20. Tell us what you hope to learn from the City of Nampa's Citizen's Academy:*
24. Electronic Signature

    By checking the box and entering your information below, you hereby declare, under penalties of perjury, that you are authorized to submit the information in this form and to the best of your knowledge, it is true, correct and complete.

26. Signature*

    1. Signature
27. First Name*
28. Last Name*
30. Email*
31. Date*
    Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field