Neighborhood Night Out Participation Form

Form Deadline: Friday, July 21

Please Note: Registration is limited to members of Coliseum Central Business Improvement District. Your organization must have a commercial (excluding manufacturers, residential and multi-family properties) address located in the BID. If you are unsure as to whether your address is located within District boundaries, click here.

Event Date: TBD
Event time: 4-7PM
Participant Set-up: 1PM
Location: Hampton Roads Convention Center

Neighborhood Night Out Participation Form
Organization Name(*)
Invalid Input
Contact Person(*)
Invalid Input
Coliseum Central Business Address
Invalid Input
Mailing Address(*)
Invalid Input
City(*)
Invalid Input
State(*)
Invalid Input
Zip(*)
Invalid Input
Telephone: Work(*)
Invalid Input
Mobile
Invalid Input
Email(*)
Invalid Input
Alternate Contact
Invalid Input
Phone
Invalid Input
Day of Contact
Invalid Input
Phone
Invalid Input
All participants must somehow be related to health, wellness, safety, or crime prevention. If your business/organization is not specifically related to health or safety, you may link your business to some aspect of health or safety. For example, a bank may provide information related to counterfeit money, credit card fraud or giveaways.
Please describe below what your organization/business plans to do at the event:(*)
Invalid Input
Will you need electricity?
Invalid Input
Will you need a table & two chairs?
Invalid Input
Are you planning to bring a canopy/pipe & drape?
Invalid Input
Electrical outlets are limited at the event site. We will do our best to accommodate your needs.

Cloudy

56°F

Hampton

Cloudy

Wind: 11 mph