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Friends of Civitas Sign-up Form

How Can I Help?

Member Roster

 

 

 

 

 

 

 

 

Requested Fields:

Last Name:     First Name:

Address:

City:     State:   Zip Code:

Home Phone: (xxx) xxx-xxxx
Work Phone: (xxx) xxx-xxxx    Extension:
Cell Phone:    (xxx) xxx-xxxx

E-Mail #1:    
E-Mail #2     

Optional Fields:

I became interested in Civitas because of:

Occupation:

School or work affiliation (if applicable):

I am interested in:

Adult Activities (Simulated U.N., speakers, issue forums, etc.)
Assisting students in research [area(s) of special knowledge: ]
Making a tax-deductible contribution to Civitas
Other volunteer activities (e.g. helping with event registration, providing refreshments, driving, etc.)
Researching material for Civitas activities

Thank you very much.  Please click the "Submit" button below.