National Night Out Registration Form

Organization/Business Name

Is this organization a non-profit group? If you answer no, a fee or donation will be required. Please contact Rachel Black at rblack@fairviewpolice.org or 717-901-5267 for additional information. *

Yes

No

Organization Representative Name *

Email Address *

Phone Number *

Planned Informational Booth/Activity *

Will this booth/table require access to electricity? *

Yes

No

Are you bringing a display vehicle? *

Yes

No

Display Vehicle Details

I understand that vendors must provide their own tables, chairs, and canopies. If I bring a canopy, I will bring weights or stakes to secure it to the ground. *

Yes

No

Do you have any special requests or require a space larger than 12’x12’? If so, please advise below. *

In an effort to make National Night Out a free event for our community, I understand that sales will not be permitted. *

Yes

No