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Crime Free Housing Program Seminar: Tuesday, December 13, 2022 8:00 am - 10:30 am at Moline Police Department

  1. Please note, each form submission is valid for one seminar admission. Please submit a separate response for each attendee.
  2. Owner or Agent*
  3. Do you have a local agent?
  4. Please list the names and addresses of all MULTI-HOUSING properties of which you are an owner/agent. If more space is needed, please list the additional properties at the end.
  5. Disclaimer
    Due to COVID-19, the class size is limited. Masks must be worn for the duration of the class.
  6. Leave This Blank:

  7. This field is not part of the form submission.