United Way Day of Caring Volunteer Selections

ONLY ONE FORM PER COMPANY REQUIRED. THANK YOU!

COMPANY INFORMATION

Company Name

Street Address:

City/Town:

State:

Zip Code:

First and Last Name Contact Person:

Title - Contact Person:

Email Address - Contact Person:

Phone Number - Contact Person:

SELECT YOUR PREFERENCES FOR "DAY OF CARING" SERVICE OPPORTUNITY

First Choice

First Choice Selection:

Click on your selection from the drop-down list.

Please tell us the number of volunteers you have available for your first choice:

Second Choice

Second Choice Selection:

Click on your selection from the drop-down list.

Please tell us the number of volunteers you have available for your second choice:

Third Choice

Third Choice Selection:

Click on your selection from the drop-down list.

Please tell us the number of volunteers you have available for your third choice:

Please confirm the TOTAL number of VOLUNTEERS who will be serving on Day of Caring:

Total Number who will be attending the Day of Caring Breakfast:

	Small:	Medium:	Large:	XL:	2X:	3X:	TOTAL number of t-shirts ordered:
T-SHIRT ORDER

Additional comments or information we need to know in order to coordinate your group with the agency selected:

Date Completed