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NOTICE OF INTENT TO PICKET

2. 
4. NOTICE OF INTENT TO PICKET
   A group of fifteen or more persons shall give notice of intent to picket in writing. A group of fewer than fifteen persons may give written notice of intent to picket but is not required to do so.
6. Picket/Pickets/Picketing
   To make a public display or demonstration of sentiment for or against a person or cause, including those demonstrations which may include the distribution of leaflets or handbills, the display of signs and any oral communication or speech, which may involve an effort to persuade or influence, including all expressive and symbolic conduct, whether active or passive, upon those portions of the public street and sidewalks not used primarily for vehicular parking and moving traffic and not constituting a parade.
8. Today's Date:*
   Today's Date:
10. Name of Person/Group Submitting Notice of Intent to Picket:*
12. Address*
14. City*
15. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
16. Zip Code*
18. Phone Number*
19. Alternate Number
21. Email Address*
23. Begin Date of Activity:*
    Begin Date of Activity:

    Begin Date of Activity:
24. End Date of Activity:*
    End Date of Activity:

    End Date of Activity:
26. Estimated Attendance:*
28. Name of Sponsoring Person or Group: *
30. Address of Sponsoring Person or Group:*
32. City*
33. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
34. Zip Code*
36. Phone Number*
37. Alternate Number
39. Email Address
41. Location of Assembly and Demonstration:*
43. Will Any Persons Under 18 Years Old Be Participating in the Activity: *
    -- Select One --YesNo
45. Name of Person or Persons In Charge of Activity:*
47. Address of Person or Persons In charge of Activity:*
49. City*
50. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
51. Zip Code*
53. Phone Number*
54. Alternate Phone Number:
56. Email Address*
58. The Person or Persons in charge of the activity shall accompany the activity at all times and have in their possession a copy of the receipt of the Notice of Intent to Picket.
60. A receipt of the Notice of Intent to Picket will be returned to the person/group submitting the notice.
62. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
64. Electronic Signature*
66. Date of Signature*
    Date of Signature
68. Questions? Please contact:
    Karen Rimmer Special Event Coordinator High Point Theatre 220 E. Commerce Avenue High Point, NC 27260 Phone: 336-883-3625 karen.rimmer@highpointnc.gov
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field