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HCC College Registration Form

*All Fields are required for online registration.

Member Name (last, first):
Address:
City: State: Zip:
Daytime Phone: Evening Phone:
E-mail:
Neighborhood
  1. Are you a neighborhood association member? Yes No

  2. Are you a neighborhood association officer? Yes No

  3. How long have you lived in your current neighborhood? (years)

  4. How much time do you spend a week on your volunteer & neighborhood activities? (hours)

  5. How much time would you like to spend?

  6. How did you first learn about the College?

How would your participation in the Hampton Civic Community College help you increase your contribution to your neighborhood? (i.e. Is there a challenge that you face in your organization or a project/issue that you are working on that you could be better prepared to address with additional leadership training?)
 
Please be specific. (Allow up to 500 words in block)
 
I hereby agree to participate in the Hampton Civic Community College and I am committed to attending all of the programs sessions which include evening sessions and a Saturday Neighborhood tour. (Applicants must check box in order to submit their application)
 
By checking this box, it serves as your signature and you agree to the following terms.
 

Please wait while your form is processed.

Thank You!

Thank you for your submission. We will respond to you as soon as possible.
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