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2. First Name*
3. Last Name*
5. Business Name (non-resident)
6. Civic Organization Name (non-resident)
8. Email Address*
9. Phone Number*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Age Range*

    1. 18-29
    2. 30-39
    3. 40-49
    4. 50-59
    5. 60-69
    6. 70-79
    7. 80+
18. T-Shirt Size*

    1. S
    2. M
    3. L
    4. XL
    5. 2X
    6. 3X
20. Number of Years Living or Working in Loveland*
22. Upload a picture of yourself (to be used in a class session).*
24. Bio - Tell us about yourself including your work history, family, interests, accomplishments, community involvement, etc.*
26. List any civic, professional, business, religious, social or other organizations in which you are a member. If you are new to Loveland, you may include activities in your prior location.*
28. In your opinion, what is the difference between being a resident and being a citizen.*
30. Briefly discuss what you hope to learn as a participant of Loveland U and how you anticipate using the information.*
32. Do you have any special areas of interest or anything you would like to learn more about related to local government?*
34. How did you hear about Loveland U?*
36. Are you a member of any Loveland Board or Commission?*

    1. No
    2. Yes
37. Are you planning to attend all 10 sessions?*

    1. No
    2. Yes
39. Name
    Product Name
40. Price
41. Quantity
42. Shipping Cost
44. Taxable
46. Acknowledgements & Permissions*

    1. I plan to participate in all 10 sessions and understand that if I miss more than two sessions I will not be able to graduate with my class.
    2. If selected to participate in Loveland U, I agree to pay a fee of $99 to help offset the cost of the program and meals that will be provided at each session.
    3. I understand that in the interest of fostering diverse perspectives and enhancing the participants' experience, candidates will be selected to achieve a balanced class.
    4. I consent to being photographed or video taped while participating in Loveland U and authorize the photos and videos to be published for any purpose and in any form by the City of Loveland.
48. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
50. Electronic Signature
Leave This Blank:


52. Calculate Totals Proceed to Checkout

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