NOTICE: THIS FORM IS FOR INTERNAL USE ONLY. SENIORS WHO WOULD LIKE TO REGISTER MUST CALL 904-255-5667 AND LEAVE A MESSAGE. ANY REGISTRATIONS USING THIS FORM WILL NOT BE HONORED. 

Thank you for your interest in the 2022 Jacksonville Senior Prom, which will be held on Friday, August 5 from 5 - 8 p.m. at the Prime Osborn Convention Center. Each attendee will need to complete the form below and must be a Duval County resident age 60 and over. Please indicate any organization affiliation you may have, as well as if you require a vegetarian option for meals. If you have any questions, please call the Senior Events Hotline at 904-255-5667. 


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Please complete to send confirmation to senior upon completion.
If choosing 'Senior Housing', 'Senior Ministry', or 'Other Organization' please provide organization's name below.