Special Needs Volunteer Form

Area 45 Special Needs Committee

Please fill out this form, and click the submit button at the bottom

This form is provided for those who would like to be of service by arranging to bring a meeting to someone who can’t get out due to health or other special circumstances

First name......................

Last Name or Initial......

Male/Female...................

Home group…...........…

Hometown……..........…

Email……............………

Phone…………..............-- Ext-

Special instructions....

I would like to be of service:

By taking a meeting to a homebound person………...…

By taking a meeting to a person in a nursing home…...

By taking a meeting to a person in a hospital……....……

Other special situation…..

How can we best contact you?

*link to download the free Adobe® Acrobat® Reader

Send mail to "helpandinfo at snjaa dot org" with questions or comments about this web site. e

NOTE: as an effort to minimize SPAM, website email addresses are no longer clickable. You must type in the address in the proper format. For example if the address says; someone at snjaa dot org you would type in someone@snjaa.org 2Remember email addresses NEVER contain spaces

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Last modified: 12/13/2006