2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number
14. Home Phone Number
16. Email Address*
18. How long have you lived in Kennewick?*
20. What do you like the most about Kennewick?
22. What do you think are the major challenges for Kennewick?
24. What do you wish to learn from the Citizen's Academy?
26. Disclaimer and Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) this application may be made available for public inspection, including inspection by members of the press and media.

    1. I agree.
28. Electronic Signature
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30. 1. Receive an email copy of this form.
31. Email address

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32. Submit Submit and Print

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