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Community Camera Registration Program Form

2. Community Camera Registration Program Form
   To register your security cameras with the Mitchell Police Department, please complete and submit this form. Mitchell Police Department personnel will contact you to process the registration. So that we can best respond to you message, please fill in as much of the following as possible:
4. First Name*
5. Last Name*
7. Business Name (Optional)
9. Address Number*
   Example: 201
10. Street Name*
    Example: West 1st
12. City*
13. State*
15. Zip Code
17. Phone Number*
18. Email Address*
20. Best way to reach you*

    1. Phone
    2. Email
22. Number of Cameras*
    -- Select One --12345+
23. How many days are images or videos stored?*
25. Location of each camera and Description of view:
    Example: Camera #1 southwest corner of building facing 5th Ave.
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field