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Church/Organization Individual Name
Contact Person
Address
County
Phone
Email Address
Time Preference(s) of Volunteering:
Morning Weekends Evening Weekdays
Facility at which you are willing to volunteer:
Adult Male Adult Female Juvenile Male Juvenile Female
Please check area(s) of interest:
PLUS Core Curriculum presentation PLUS Small Group Facilitator Victim Impact/Education Community Service Mentor, Individual Mentoring Faith Community Mentoring Community Organization Arts/Cultural Programs
Seminar Participation Spiritual Advisor (visitation) Employment Transportation Housing Donations Other (please describe below)
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