1. Name of Party Host: *
Organization (if any)
2. Phone Numbers of host *
	Home
	Work
	Mobile
3. Street Address of host:*
City, State, Zip *
4. Email Address of host:*
5. Name of Co-Host, if any:*
6. Co-Host Phone Numbers:
	Home
	Work
	Mobile
7. Address of Event*
8. Cross Street of Event*
9. Approximate start and end time of your event?*
10. Approximate Number of Adults Expected:*
11. Approximate Number of Children Expected:*
12. This is our (1st, 2nd, 3rd, etc.) NNO Celebration.*
13. Do you plan to block off your street?*
	Yes
	No
14. If yes, state where your street will be blocked off (i.e. specific address/cross streets)*
15. How did you learn about NNO? *
Please note, if you plan to block off your street, you will NOT need to obtain a block party permit or complete a petition this year. Notifying us at the time of registration is sufficient.
Also note: Consent for release of information. You are not required to release any information to the press to participate in National Night Out. If you do consent, the Oakland Police Department cannot guarantee press coverage. The Department will simply make this information available, if requested.
I, , hereby authorize the Oakland Police Department to distribute the time and location of this National Night Out event to the press. I understand members of the press may choose to cover this event and hereby give my permission.
(Date)