3. 
6. Video Sharing Program
9. Elmhurst Police Department
12. (630) 530-3050
16. First Name*
17. Last Name*
19. Check one:

    1. Residence

    1. Business
21. Address1*
23. Address2
25. (If you have cameras at more than one address/location please register each address/location separately)
27. Preferred Telephone Number:*
29. Secondary Telephone Number:
31. Email:*
33. Number of Cameras at Location:*
35. Camera Views:*

    (Please check which are applicable)

    1. Front
    2. Rear
    3. Sidewalk
    4. Driveway
    5. Parking Lot
    6. Other
37. To be eligible to participate in the video sharing program the video camera must be in the City of Elmhurst
39. Thank you for registering with the Elmhurst Police Department video sharing program. The information you have provided to us will be used for investigation purposes only, and will not be disseminated for other solicitations of the City or for any commercial purposes. If you have any questions about this program, contact Deputy Chief Robert Tannehill by email robert.tannehill@elmhurst.org or (630) 530-3050.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field