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2. First Name*
3. Last Name*
5. Mailing Address*
7. Physical Address*
9. City*
10. State*
11. Zip Code*
13. Contact Number*
14. Alternative Contact Number
16. E-Mail Address*
20. Committee For Which You Are Seeking Appointment

    The Town of Middleburg utilizes both regulatory and advisory committees in order to conduct Town business.  Please identify the committee for which you are seeking an appointment.    

22. Regulatory Committee For Which You Are Seeking Appointment

    1. Middleburg Planning Commission
    2. Historic District Review Committee (HDRC)
    3. Board of Zoning Appeals (BZA)

    The above are regulatory committees, which means that depending on the type of application, they may take formal action.  In some cases, the Committee may make a recommendation to the Town Council, who is then responsible for taking final action.  Per State Code, most of these committees have residency requirements.   

24. Advisory Committee For Which You Are Seeking Appointment

    1. Middleburg Arts Council (MAC)
    2. Middleburg Sustainability Committee (MSC)
    3. Middleburg Strategic Finance Committee (MSFC)
    4. Cultural & Community Events Committee (CCEC)
    5. Economic Development Advisory Committee (EDAC)
    6. Streetscape Committee

    The above are advisory committees, which mean they advise the Council.  They may also be responsible for certain activities/events once they are approved by the Council.  Generally, there is not a residency requirement for advisory committees. 

28. Qualifications for Appointment to Committee*

    Please describe your qualifications for service on the committee for which you are seeking appointment.  You may also attach a copy of your resume or other pertinent information that you would like to be considered during the appointment process. 

30. Resume
32. Other
36. 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.
38. Electronic Signature
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41. Email address

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