City of Peoria, Arizona Neighborhood Services

Neighborhood Services
Registration Form

Community Development Department
Neighborhood Services
9875 N. 85th Ave, Peoria, AZ 85345
Phone: 623-773-5140 Fax: 623-773-7245

INSTRUCTIONS: Please complete the information about your organization below and ensure all requested information is complete. Once you have completed filling in your information, click the "Submit" button.

Neighborhood Information

Organization Name:

Year established:

Represents:

Single-family Households Multi-family Households

Commercial Properties Vacant Lots

Organizational Boundaries:
(List street boundaries)

North:

South:

East:

West:

List schools, parks and churches within the organization's listed boundaries: (List names and addresses)

City Council District:

Check all that apply:

HOA Block Watch *Governed by Management Company

*If governed by a Management Company, please provide contact information:

Representative's Name:		Phone:
Management Company:		Fax:
Address:		Email:

General Information

Primary Contact

First Name	Last Name	Middle Initial
Address	City	State
Zip Code	Phone
Email	Alt. Phone

Secondary Contact

First Name	Last Name	Middle Initial
Address	City	State
Zip Code	Phone
Email	Alt. Phone

Board Members

President:

Vice-President:

Secretary:

Treasurer:

Organization Web Address:

Meetings:

Monthly Annual Other

Meeting General Location:

Meeting Time:

List of neighborhood concerns/issues: