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2. INSTRUCTIONS - Do not sign-in / Submit this form ONCE

   Submit this form AFTER purchasing your annual pass at the park. To exchange your temporary pass receipt for a placard, complete all applicable fields. Requests should be submitted within 7 days from date of purchase. Incorrect data or submitting this form more than once WILL DELAY processing. If you haven't received your placard within 14 days, contact the parks department at 425-388-6600.

4. First Name*
5. Last Name*
7. Address*
   Enter address placard is to be mailed
8. Address2
10. City*
11. State*
12. Zip*
14. Email*
15. Phone1
17. Place of Purchase*
    -- Select One --Flowing Lake (Lechies Beach) ParkKayak Point ParkWenberg ParkWyatt/Davies Beach

    Select the park where you purchased your pass

18. Not Eligible

    1. Contact City of Lake Stevens

    Passes purchased at Wyatt Park/Davies Beach are not eligible for the Snohomish County Parks pass.  Contact the City of Lake Stevens to redeem tickets purchased there. 

20. Date of Purchase
    Date of Purchase
21. Transaction Number*

    This number MUST MATCH the 6-digit number on your receipt. Include all zeros.

23. Copy of receipt*

    Please attach a picture of your receipt. Ensure transaction number is legible. Limit file size to 2mb

25. Note:  Select SUBMIT if you do not get a "Success" message after selecting Submit and Print.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field