APPLICATION FOR HAMPTON HOUSE MEMBERSHIP Please complete this form to apply for a Hampton House Membership. Owner 1: Name * First Name Last Name Owner 1: Date of Birth (ex. 01-01-80) * MM DD YYYY Owner 1: Cell Phone * (###) ### #### Owner 1: Email Address * Owner 1: Digital Signature * Owner 2: Name First Name Last Name Owner 2: Date of Birth (ex. 01-01-80) MM DD YYYY Owner 2: Cell Phone (###) ### #### Owner 2: Email Address Owner 2: Digital Signature Additional Member Living at Residence 1: Name First Name Last Name Additional Member 1: Date of Birth (ex. 01.01.80) MM DD YYYY Additional Member 1: Phone (###) ### #### Additional Member Living at Residence 2: Name First Name Last Name Additional Member 2: Date of Birth (ex. 01.01.80) MM DD YYYY Additional Member 2: Phone (###) ### #### Additional Member Living at Residence 3: Name First Name Last Name Additional Member 3: DOB (ex. 01.01.80) MM DD YYYY Additional Member 3: Phone (###) ### #### Additional Member Living at Residence 4: Name First Name Last Name Additional Member 4: DOB (ex. 01.01.80) MM DD YYYY Additional Member 4: Phone (###) ### #### Additional Member Living at Residence 5: Name First Name Last Name Additional Member 5: DOB (ex. 01.01.80) MM DD YYYY Additional Member 5: Phone (###) ### #### Property Address * Is this a Rental Property? * Yes No If this is a rental, please list owner name, address, and phone # (Hampton House must obtain approval by the owner for use of the membership by renter) Thank you for completing this membership form. We look forward to having you as a member of the Hampton House! We will be in contact with you shortly for your next steps.Thank you!Hampton House Staff
