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MITZVAH CORPS - VOLUNTEER APPPLICATION |
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Participant's First and Last Name
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Mother's Name
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Participant's
E-mail Address
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Father's Name
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Participant's
Cell Phone Number
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Family E-mail Address
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Home Phone Number
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Mother's
Cell Phone Number
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Grade and School
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Father's
Cell Phone Number
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Mailing Address
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City, State Zip
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TELL US A BIT ABOUT YOURSELF! |
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Hobbies:
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Count Me In For:
Lawn Mowing/PLanting Flowers/Raking Leaves
Grocery Shopping
Painting
Snow Shoveling
Changing Light bulbs/Batteries
Moving/Packing Boxes/ Furniture Schlepping
?!?! I Love Surprises....I'll Do Almost Anything!
Other
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Talents:
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Interests:
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MITZVAH CORPS SWEATSHIRT |
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Youth SM Qty: Youth MD Qty: Youth LG Qty: Youth XL Qty:
Adult SM Qty: Adult MD Qty: Adult LG Qty: Adult XL Qty:
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REGISTRATION |
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$18 - Registration Fee For One Volunteer - Includes Sweatshirt And All Programs |
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SUPPORT THE PROGRAM |
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Yes! I/We would like to support the program with a contribution of (OPTIONAL): |
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$180 - Sponsors a Mitzvah Mission |
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$360 - Sponsors 12 Senior Connections |
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Other Amount: |
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Please confirm the total to be charged to your credit card for your contribution and registration: |
| Name on Card: |
Card Number: |
| Card Type: |
Exp. Date: |
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PARENTAL PERMISSION |
| I give my son/daughter permission to participate in the Mitzvah Corps programs. |
| Signature: Date: |
