Sign to support incorporation

Thank you for supporting the creation of the Village of Wainscott. Please fill in the below information.

First Name

Last Name

Wainscott street address (i.e., not P.O.)

Mailing address

Mailing city

Mailing zip

Phone

Additional petition signer names (if any)

Additional petition signer email address(es)

Are you already registered to vote in Wainscott?

If not, would you like a voter registration form?

Additional household members so we have a complete list of 'regular inhabitants'

Additional comments (if any)