Report and Request

2. Here is your chance to be included in the Town's new online Resident Directory. This is a great way to contact and meet your neighbors. The Resident Directory is completely private and accessible only to Town residents. To be included, you must complete and submit the authorization form below. Please contact the Town office at townoffice@townofchevychase.org or 301-654-7144 if you have any questions.

4. Name*
5. Name #2 (if applicable)
7. If you have different surnames, please specify how you would like them to appear:

   1. Jane Doe and John Smith (listed alphabetically under Doe and Smith)
   2. Jane Doe and John Smith (listed only under Doe)
9. Street Address*

   Chevy Chase, MD 20815

10. Phone Number (1 per household)
12. Email Address (1 per household)
14. Authorization*

    I authorize the listing of the information provided above in the Town of Chevy Chase Resident Directory that will be accessible only to Town residents.

    1. I agree
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field