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2. Community or Neighborhood Group Registration Form

   Community Groups must acknowledge service to Roseville residents as the central component of the organization's objective. At least 50% of group membership must consist of Roseville Residents. Requested facility use is open to all Roseville residents, is non-discriminatory and non-political in nature. 

   Neighborhood Groups must acknowledge service to Roseville residents as the central component of the organization's objective. Group membership must be 100% Roseville Residents. Requested facility use is open to all Roseville residents, is non-discriminatory and non-political in nature. 

4. First Name of Main Contact*
5. Last Name of Main Contact*
7. Which type is your group - Community Group or Neighborhood Group?*
9. Community Group or Neighborhood Group Name*
11. Address*
13. City*
14. State*
15. ZIP*
17. Phone (123-456-7890)*
18. Email*
20. If your group has a website please enter it below:
22. What is the mission or objective for your group?*
24. Does your group have 501(c)(3) status?*

    1. Yes (required for Community Groups; email a valid document to scott.breuer@cityofroseville.com)
    2. No
26. How many people are in your group?*
28. What percentage of your group members are residents of Roseville (55113 zip code)? Note, the city may request proof of membership residency*
    -- Select One --100%75-100%50-75%25-50%0-25%
30. By entering my name below, I verify that I have read and understand the policies for Community & Neighborhood Groups in Roseville, and agree to ensure that the above group abides by them. I understand that failure to abide by the policy may result in punitive measures, including revocation of facility usage.*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field