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2. 
4. Full Legal Name ( As printed on Driver's License or State Identification Card)
6. Address
8. City
9. State
10. Zip Code
12. Phone Number
14. Email Address
16. Are you purchasing in East Chicago? (Select One)*

    1. Yes

    1. No
18. What is the date of the workshop that you would like to attend?
    What is the date of the workshop that you would like to attend?
20. Please provide the money order or cashier's check number.*
21. Select the amount of payment *

    1. $27 for Current East Chicago Residents
    2. $127 for Non East Chicago Residents

    The $27 workshop fee is for current East Chicago residents. With a valid Indiana Driver's License or State ID with your East Chicago, IN address. And plans to purchase a single-family home in East Chicago. *After providing money order or cashier's check number all payments must be submitted in person to City Hall. [4525 Indianapolis Blvd (46312)]

23. Please make lunch selection. (Check one)*

    1. Turkey Sandwich
    2. Ham Sandwich
    3. California Veggie Sandwich
    4. Garden Salad
25. Attach photo of the front of your Driver's License or State ID Card*
26. Attach photo of the back of your Driver's License or State ID Card*
28. 
30. 
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit