2. Please keep suggestions polite and related to Recreation. 

   DO NOT SUBMIT REQUESTS TO SIGN UP FOR ACTIVITIES THROUGH THIS SUGGESTION BOX. YOU WILL NOT BE SIGNED UP FOR ANYTHING USING THIS FORM.

4. Name
5. Address, City, Zip
7. Phone
8. Email

   The email collected here will only be used to communicate with you regarding this form.

10. I live here:

    1. Full Time
    2. Part Time
    3. Just Visiting
11. If you live here here part time please indicate what months you are in Jupiter below.

    1. January
    2. February
    3. March
    4. April
    5. May
    6. June

    1. July
    2. August
    3. September
    4. October
    5. November
    6. December
13. Please select all movie ratings you are comfortable with:

    1. G
    2. PG
    3. PG-13
    4. PG-17
    5. R
14. Would you be willing to have events with other city recreational groups?

    1. Yes
    2. No
    3. Maybe

    For example, Palm beach Gardens, Tequesta, North Palm Beach.

16. If there was a special event at night, would be willing to drive at night?

    1. Yes
    2. No
    3. Maybe

    For example, a masquerade ball or special occasion dance. 

18. Additional Comments:*
20. If we have questions may we contact you?*

    1. Yes
    2. No
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field