Name:
Email Address:
Phone Number
Alternate Phone Number
What are your talents/special interests? (check all that apply) Cooking
Crafts
Building projects
Electrical work
House painting
Singing
Organizing
Fundraising
Ideas
Other
If you chose "other", please list these talents/special interests here
What areas would you like to be involved in with the Civitan Club?
Please list your place of worship (if applicable)
Do you have children? Yes
No
If yes, how many? 1
2
3
4
5
6
7
Please list their names and ages (1 per line please)
What is your availability for working with the Civitan Club projects? Sunday AM
Sunday PM
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Saturday AM
Saturday PM

 

 

 

 

 

 

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