| *Your Name |
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| Address |
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| City |
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| State |
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| Zip Code |
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| Phone Number |
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| Best time to contact you |
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| *Your E-mail Address |
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| Are you age 18 or older? |
yes |
no |
| Occupation |
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| Company you work for |
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| Committee and other Service Learning |
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| Office Work (includes typing, filing, mail preperaition, telephone) |
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| Public Relations
(newsletter writing, advertising, web-site updates, telephone, and scheduling) |
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| Speaker’s Bureau (community presentations, display booth staffing, greeters at special events) |
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| How did you discover Habitat for Humanity |
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| Friends/Relatives |
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| Prior Experience |
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| Newspaper article / advertisement |
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| Radio story / advertisement |
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| Billboard |
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| Flyer / Church bulletin |
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| Store Customer |
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| Walk-in |
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| Newsletter / Donor Letter |
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| Television story / advertisement |
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| Other (please describe) |
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| Questions / Comments |
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