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2. Please enter through the Fire Department / Community Development & Building Department Door.
4. First Name*
5. Last Name*
6. Phone Number*
8. Email *
10. Are you a Groveland Resident?*
    -- Select One --YesNo
11. If yes, what is your address?*
13. Organization / Affiliation*
15. Please tell us what kind of meeting you're looking to host in the EOC / Media Community Conference Room?*
17. Date and Time Requested*
    Enter the first choice for the requested date and time of meeting.
19. Second Date and Time Requested*

    Please enter a secondary date in case your first one is unavailable.

21. Agreement*

    By clicking "I Agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature. Signee is responsible for any and all damages incurred.

    1. I agree.
23. Applicant's Signature*
    Please type name
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field