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2. Completing this form is voluntary. It will be utilized by the City of Valparaiso for informational purposes. Upon submitting this form, you will be contacted by the city, your meeting information will be posted to the neighborhood calendar and you will receive future information related to neighborhoods.
4. Neighborhood Group Name*
6. Primary Contact Person*
8. Primary Contact Phone*
9. Primary Contact Email*
11. Do we have your permission to list your name and email address on our directory?*

    1. Yes
    2. No
13. Secondary Contact Person
15. Secondary Contact Phone
16. Secondary Contact Email
18. Address for Information to be Sent (if applicable)
20. Address2
22. City
23. State
24. Zip
26. General Neighborhood Boundaries*
    Please define the general neighborhood boundaries to the north, south, east and west.
28. Is your neighborhood:*

    1. New / Just Forming

    1. Active

    1. Incorporated (501(c)3 or other)

    1. Traditional HOA or POA
30. How often does your group meet?
31. Meeting Date/Time/Location
    example: 2nd Tuesday of the month at 7pm at the library, etc.
33. If you are an established organization, are you a:

    1. Board Member

    1. Officer

    1. Volunteer

    1. Other
35. Number of Active Members
36. Do you have or intend to have Bylaws?
38. What are current activities and goals for your neighborhood group?
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field