Name *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

MM

DD

YYYY

Phone *

Best phone number at which to reach you

(###)

###

####

Volunteer Areas *

Put a check mark next to any of the areas you may be interested in for volunteering

Assist with Mailings (weekdays a.m.)

Bingo (W, Th 12:30 pm - 3:30 pm)

Board Member

Book Club Coordinator

Commodity Pick-up

Dining Room (pick your weekday 11:45 am - 12:45 pm)

Exercise Class Leader (dependent on class)

Health Dept Volunteer

Library

Making Gift Shop Items

Home Delivered Meals - leaving from Altru (pick your weekday 11 am - 12:30 pm)

Meals on Wheels - leaving from the GF Senior Center (pick your weekday 10:30 am - Noon)

Entertainer (usually Fridays at 1 pm)

Office Help

Silvertones Chorus

Special Events

Tech Support for Seniors

Acknowledgment of Enrollment *

I understand the Greater Grand Forks Senior Citizens Association, Inc may obtain a statewide database background check if deemed necessary (primarily for our Meal Delivery volunteers).

Please check in place of a signature

Today's Date

MM

DD

YYYY