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2. Workplace Name*
4. Workplace Address*
   Must be located within Hampton city limits
6. Type of Workplace
8. Workplace Contact Person*
10. Workplace Contact Phone or Email Address
12. Nominator Name*
14. Nominator Email Address*
16. Clean & Green Workplaces Qualities: Please Check All That Apply!

    1. Litter-free efforts apparent
    2. Attractive premises
    3. Contributions to community
    4. Recycling and/or waste reduction efforts
    5. Trash and ash receptacles
    6. Urban forestry and tree stewardship
    7. Sustainable landscaped areas
    8. Energy conservation practices
    9. Water conservation practices
    10. Heritage preservation
    11. Overall impressions of workplace
    12. Other

    Please check all that apply.
18. Brief Explanation of Why This Business Show Win A Clean & Green Workplace Award:
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field