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Partners for a Better Palmdale

Interest Form

* = Required Field
NOTE: If incorrect or incomplete information is provided, there is no guarantee that your form will be processed.

Please use only letters and numbers, commas, periods or apostrophes in the form fields.
Other special characters will not be allowed.

* Name:

Title:

Agency:

* Mailing Address:

* Phone:

* E-mail Address:

* Confirm E-mail Address:

Please check all appropriate boxes for any program you are interested in being involved in:

Youth Programs
Family Education and Mediation Programs

Areas of interest:

Neighborhood Watch

Would you like to start a Neighborhood Watch group in your neighborhood? Yes No

Volunteer for the City of Palmdale

Areas of interest:

Participate on a Neighborhood Commission

Do you have any previous board or commission experience?
Yes No

External Task Force
Neighborhood Houses
Attend the Citizens Academy

Any other comments or suggestions?

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