2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Current Employer*
16. Age Bracket*

    1. 18-29
    2. 30-49
    3. 50-69
    4. 70-89
17. Are you available to participate in the Newnan Citizen Academy on the dates listed?*

    1. Yes
    2. No
    3. Maybe

    You must be present and attend 5 out of the 6 listed dates to graduate from the Academy: September 9, 16, 30, October 7, 21, and 28

18. Are you a City resident?*

    1. Yes
    2. No
20. Do you own a business in the City limits?*

    1. Yes
    2. No
21. If "Yes," name the business:
23. How long have you lived, worked, or owned a business in Newnan/Coweta County? (Years)*
24. Will you need ADA (Americans with Disabilities Act) assistance? Some stairs necessary.*
26. Please, share why you would like to attend the Newnan Citizen Academy:*
27. This program includes two (2) meals and snacks. Please, list any dietary restrictions:*
29. T-Shirt Size*

    1. XS
    2. S
    3. M
    4. L
    5. XL
    6. XXL
    7. XXXL
30. How did you hear about the Newnan Citizen Academy?*

    1. Social Media
    2. Newnan Times-Herald
    3. Friends/Family
    4. Other
Leave This Blank:


31. Submit

* indicates a required field