To close off your street and register your block for your
"Night Out" activities, complete the following information.
Please help us by being as precise as possible.

Because of the volume of registrations received, no official notification will be sent out. Unless you receive your registration back, assume that it has been received and that your block is ready to go. Coordinators will not contact you to verify receipt.

Last Name:

First Name:

Address:

Email:

Zipcode:

Home Phone:

Work Phone:

Census Tract: [Find your census tract]

Is your group an active Block Watch?

If no, would you like information on forming a Block Watch?

Is it OK to have media coverage of your event?

What types of activities do you plan for your
"Night Out" activities?

Are you planning on closing your street for "Night Out?"
Yes No

If yes, Street name and 100 block to be closed:

From: (Cross Street)

To: (Cross Street) (Please remember, arterials and intersections cannot be closed.)