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First Name (required)

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Last Name (required)

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Phone (required)

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Name of Block Club/Association (required)

(i.e. 75th & Paxton Block Club or XYZ Tenant Association

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Are you a Block Club Leader or Member or a resident not registered with a block club? (required)

Please check one. Block Club Members are general members of their clubs and do not hold an office. Club Leaders hold an office such as Pres., Secretary, etc.

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Which office do you hold? (required)

If you don't see yours listed, please choose the closest one.

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Would you like to start a block club or association?
Clear

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Who can see this field?
Please type 1234 in the "Test Field" above

A temporary security measure

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