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Lincoln Heights Neighborhood Council - Join Step 1
Lincoln Heights Neighborhood Council
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Lincoln Heights Neighborhood Council - Join Step 1

Join

If you would like to register as a Stakeholder in our Neighborhood Council, please fill out the following registration application.

Directions: Required fields are the First Name, Last Name, Email, Username and Password. The Username must not contain any spaces. For example: 'my name' won't work, but 'myname' will. Lastlly, the Password must contain at least 6 characters and you must type it in both fields exactly the same. The Join process is simple but exact and you must follow these directions to complete the process. Only the required fields must be filled in. The other fields are totally optional.


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First Name (Required)  
Last Name (Required)
Company Name (if any)
Address 1
Address 2
City   
State
ZIP
Email (Required)
Phone  
Mobile/Cell
Other
Stakeholder Type:
To select more than one, use Ctrl Key + Click for PC and Command Key + Click for Mac.
Interests:
(Language, Committees, etc.)
If you are a non-resident stakeholder please provide the following:
First Name
Last Name
Business Name
Address 1
Address 2
City   
State
ZIP
Email
Phone  
Mobile/Cell
FAX


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Personal Information (optional)
Gender Male
  Female
Ethnic Background Non Latino Caucasian
  Black/African American
  Latino/Hispanic
  Asian/Pacific Islander
  American Indian
  Other/Declined to state
Residence Status Rent/Lease
  Home Owner
  Business Owner/Employee
  Other
Age Group Under 18
  19 - 30
  31 - 39
  40 - 50
  51 - 65
  Over 65
Please Enter The Following Required Account Information:

User Name (Required)
Password (Required - 6 characters minimum)
Password (Enter again)
 
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