2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email*
15. Phone:*
17. Are you under the age of 18 years old?*

    1. Yes
    2. No
19. If yes, please provide name and contact for legal guardian
21. Indicate Top 3 Gift Card Choices for Elmhurst Businesses
    Note: Must be brick and mortar businesses
23. Business #1*
25. Business #2*
27. Business #3*
29. I agree to allow the City of Elmhurst to use the photos I provided for marketing and promotional purposes in advertising platform.*

    1. YES
Leave This Blank:


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

    This field is not part of the form submission.

33. Submit

* indicates a required field