Please complete this form and return postmarked by June 30. Submission of the form will indicate that you intend to participate in the awards competition. List up to five projects that you plan to feature in your Project Report Book and present to the judges during their visit.

Fill in all areas then click on Submit button to send in.

These projects in your Project Report Book will be the primary focus of the judges.

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Please fill in this area with the name, address, phone and email address for your mayor, Chamber of Commerce and other community betterment members that wish to receive Missouri Community Betterment information.

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For MCB office use only:
Date received _________

Name of Community/Neighborhood	Population (2000 Census)
Name of Community Betterment Organization	Phone
Name of Adult Chairperson	Fax
Address	Zip Code
City	Email Address