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6. APPLICATION FOR NOMINATION TO THE MAIN STREET HAMPTON BOARD
8. Basic Information:
10. Name:
12. Email Address:
14. Phone Number:
16. Home Address:
18. City:
19. Zip Code:
21. Employer/Business:
23. Are you the Owner?

    1. Yes
    2. No
25. Work Address:
27. City:
28. Zip Code:
30. About Yourself:
32. I am (check all that apply):

    1. A Resident of the City of Hampton
    2. A Resident of Henry County, but not the City of Hampton
    3. A Downtown Business Owner
    4. A Downtown Property Owner
    5. Available For Board Meetings the third Thursday of each month at 6:30 p.m.
    6. Available for special called meetings as and when they may arise
    7. Available to volunteer at community events
34. If you are a Downtown Property Owner what is the address?
36. My involvement in the community is as follows:

    1. Participating in local non profits
    2. Assisting in local projects
    3. Attending local events
38. My interests/hobbies/talents/skills include:
40. I am interested in serving on the Main Street Board because:
42. I will allow my name to be submitted for consideration in service to the Organization: and if appointed to serve as a member of the Board of Directors, I agree to:

    1. Attend regular scheduled monthly board meetings and committee meetins
    2. Attend eight (8) hours of training within the first year of service
    3. Attend the annual planning retreat of the board
    4. Be available to volunteer at events
    5. Participate in the policy decisions affecting Main Street Hampton
    6. Offer suggestions and create partnerships for programming and operations
    7. Seek opportunities to energize the community
    8. Serve the merchants, citizens, and visitors of Hampton to show off our vibrant City!
44. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature
48. Date:
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field