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2. Expression of Interest Form
   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 write 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 an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field