2011 National Night Out (NNO)

PLEASE FILL OUT THE BELOW FORM TO LET US KNOW OF YOUR PLANS FOR NNO, AUGUST 2, 2011

Contact Name: ____________________________________

Organization: ____________________________________

Mailing Address: __________________________________

__________________________________

Telephone Numbers: ____________________________(day)

_____________________________(evening)

E-mail Address: __________________________________

Location of Event: ________________________________

Times of Event: __________________________________

Planned Activities: ________________________________

_________________________________________________

_________________________________________________

_________________________________________________

If you have any questions, please contact Officer D. Stroman (240) 876-1277 or Dana.Stroman@montgomerycountymd.gov You can mail this form to: Ofc. D. Stroman, 2^nd District, 7359 Wisconsin Avenue, Bethesda, Maryland 20814