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  1. The name of the hosting group or organization

  2. Must be in the City of Citrus Heights

  3. 20170801_190938

  4. Enter a start and end time for your event

  5. Enter number

  6. IMG_5164

  7. Last, First

  8. Please provide a valid email address for the event organizer

  9. NNO 2016 024

  10. Planned Activity*

    What activity is your group planning for National Night Out

  11. How many times has your group participated in National Night Out?

  12. CHPD Visit*

    If available, would you like a visit from the Citrus Heights Police Department?

  13. Cell phone Aug 2016 236

  14. Leave This Blank:

  15. This field is not part of the form submission.