2. Let Us Know
4. At Civic City, we are interested in hearing what you have to say. Please fill out the following form with your questions and concerns to get involved!
6. 
   
8. Contact Information
10. Name
12. Address
13. City
15. State
16. Zip
18. Daytime Phone:
19. Email
21. How would you prefer to be contacted?
    -- Select One --PhoneEmailMailPlease do not contact me
23. 
    
25. Area of Interest
27. Please select one of the following:

    1. City Elections
    2. Construction
    3. Garbage / Recycling
    4. Junk Vehicle
    5. Loose Animals
    6. Neighbor's Yard
    7. Noise Complaints
    8. Parks
    9. Roads
    10. Sewers
    11. Street Lights
    12. Street Signs
    13. Traffic Lights
    14. Water Service
    15. Other
29. 
    
31. Concerns and Requests
33. Please give the details of your concern or request here:
35. 
    
Leave This Blank:


36. Submit

* indicates a required field