1 Start 2 Complete New date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Name of Organization: New e-mail Phone number: EIN: Number of East Providence Residents Served Last Season: Total Number of Registrations Last Season: When does the season start? Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Current Street Address: City: State: Zip Code: Authorized Representative (print) Authorized Representative (signature): Date of Signature: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026
