2. “Together, We Are Miramar” Participant Application
   “TOGETHER, WE ARE MIRAMAR” is a storytelling project with Miramar adults exploring our individual histories, sharing them with each other, and capturing the stories on video to create a portrait of Miramar. This projects will capitalize on our authentic diversity and varied heritage to create a vibrant portrait of our city. Through this, we will create a sense of Miramar, invoke community pride, and ignite creativity in our adult population. By connecting residents to Miramar and to each other using a variety of creative art forms related to storytelling, we will honor and celebrate what is authentic to Miramar and this community.
   If you are over 18 and would like to be considered for this project as a storyteller, please provide the following information:
4. First Name*
5. Last Name*
7. Birthdate:
9. Month*
   -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
10. Day*
    -- Select One --12345678910111213141516171819202122232425262728293031
11. Year*
    -- Select One --19991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917
14. Address:*
    (lease Note: You must be a Miramar resident or business owner to participate)
16. Address 2:
18. City
19. State*
20. Zip*
22. Best phone contact:*
23. Alternate Phone Contact:
25. Email:*
26. Alternate Email:
28. Name of person in household
    (if they will also be participating):
29. Age:
31. Additional Household Member:
32. Age:
34. Additional Household Member:
35. Age:
37. Country of origin (if applicable):
38. Number of years in the U.S.:*
40. Number of years in Florida:*
41. Number of years in Miramar:*
43. Statement of Interest:
    What is your Miramar story?
    What do you value about the Miramar community?*
    (500 word maximum)
45. Photograph of you/your family
    (optional)
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field