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2. Disclaimer
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
4. What type of event are you trying to plan?
   -- Select One --AuctionBaby ShowerBar / Bat MitzvahBirthday PartyCompany PartyDanceMeeting / ConferenceMemorial ServicePromRehearsal DinnerRetreatWedding CeremonyWedding Ceremony and ReceptionWedding ReceptionWedding ShowerOther
6. What date are you looking for?
   What date are you looking for?
8. Alternate Dates
10. What is your first choice on the timing of your event?
    -- Select One --Daytime HoursEvening HoursBoth Daytime and Evening Hours
12. How Many People?
14. First Name*
15. Last Name*
17. Email Address*
18. Daytime Phone Number*
20. Would you like us to mail you information?

    1. Yes

    1. No
22. Address
24. Address Line 2
26. City
27. State
28. Zip Code
29. Country
31. Comments
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33. Submit

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