Interest Form

2. Expression of Interest Form

   Please fill in the form to express your interest in the Bailey Broadband Initiative.

   Please fill in the form to express your interest in the Bailey Broadband Initiative.

4. First Name*

5. Last Name*

7. Address*

9. City*

10. State*

11. Zip*

    You must reside in the 80421 zip code area

13. Rate your level of interest in this project

    1. Willing to right check now
    2. Want to distribute cost over a bond

    1. Not Interested at all

15. Email Address

17. Comment:

Leave This Blank:


19. 1. Receive email copy
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field