Register Below For More Information Check Back Soon For Mitzvah Mission Updates and More! MITZVAH CORPS - VOLUNTEER APPPLICATION Participant's First and Last Name Mother's Name Participant's E-mail Address Father's Name Participant's Cell Phone Number Family E-mail Address Home Phone Number Mother's Cell Phone Number Grade and School Father's Cell Phone Number Mailing Address City, State Zip TELL US A BIT ABOUT YOURSELF! Hobbies: 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 Talents: Interests: MITZVAH CORPS SWEATSHIRT** Youth SM Qty: 1 2 3 4 5 6 7 8 9 0 Youth MD Qty: 1 2 3 4 5 6 7 8 9 0 Youth LG Qty: 1 2 3 4 5 6 7 8 9 0 Youth XL Qty: 1 2 3 4 5 6 7 8 9 0 Adult SM Qty: 1 2 3 4 5 6 7 8 9 0 Adult MD Qty: 1 2 3 4 5 6 7 8 9 0 Adult LG Qty: 1 2 3 4 5 6 7 8 9 0 Adult XL Qty: 1 2 3 4 5 6 7 8 9 0 ** $10 Suggested Donation Per Sweatshirt SUPPORT THE PROGRAM (OPTIONAL) Yes! I/We would like to support the program with a contribution of: $180 - Sponsors a Mitzvah Mission $360 - Sponsors 12 Senior Connections Other Amount: Please confirm the total to be charged to your credit card for your contribution and sweatshirts: Name on Card: Card Number: Card Type: Visa Mastercard American Express Exp. Date: Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select 2014 2015 2016 2017 2018 2019 2020 PARENTAL PERMISSION I give my son/daughter permission to participate in the Mitzvah Corps programs. Signature: Date: Problems with this form? Please call Misia at (414) 228-8000 ext. 211 or e-mail [email protected]. This page uses 128 bit SSL encryption to keep your data secure.
