Name of Applicant:

Address:

City:

State:

Zip:

Email address:

Please re-enter your email address:

Phone number:

Date of birth:

I am 18 years of age or older.

yes

no

I would like to work at fundraisers:

yes

no

I would like to post fliers:

yes

no

I would like to try to get donations:

yes

no