Todays Date: 01 02 03 04 05 06 07 08 09 10 11 12 / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2006 2007 2008 2009 2010

Full Name:

Address First Line:

City:

State: OH

Zip Code:

Phone Number:

Email Address: @.com

Choose one:

***Active Member                      $25 lunch fee for quarterly community AllCall meetings/
                                                         participate on a committee or serve as a liaison and
                                                        assist with at least one project a year

***Member                                $25 lunch fee for quarterly community AllCall meetings

Active HCHY                             individuals who are unable to attend meetings but would
     Support Member                        like to be kept informed/may join a committee if they
                                                       choose -- no lunch fee required

*** There is no lunch charge for members 18 & under.  Active youth members, however, need to join the youth committee or another committee.  Regular youth members need to attend at least two all-call meetings.

COMMITTEE SIGN UP FOR ACTIVE MEMBER

(Check one or more committees on which you want to participate.)

 Communications           All Call             Fundraising       Youth

Nominating       Programs          Public Relations

Please Print this form out and bring it to the next AllCall