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2. Citizen Surveillance Camera Registry
4. Contact Email:*
6. Contact Full Name*
7. Contact Phone Number*
8. Alternate Phone Number
10. Address:*
12. City
13. State
14. Zip Code
16. Type of Location:

    1. Business
    2. Residence
18. Business Name:
20. Type of Business:
22. Business Manager:
    (if applicable)
24. Is the camera monitored by a security company?:*

    1. Yes
    2. No
26. If yes, what is the name and telephone number of the company?:
28. Number of cameras th location?:*
30. Describe areas recorded
    (street view, back yard)
32. Recording Period:
    (24/7, business hours, motion activated)
34. Image Retention Period:
    (how long material is kept before it is deleted)
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field