Form

Please contact Ken Siarkiewicz at 520-818-0425
with questions. You may also print a form and send in a check.
Go to http://community-outreach.com/join - thank you! Payment
with Paypal is a secure transaction (https:)

Single Registration or Household Registration*

Single Household

First and last name of first member*

First and last name of second member*

New Members or Returning Members?*

New Returning

Active or supporting members?*

We want to volunteer for the following:

Street address*

City*

State*

Zip Code*

Local telephone number (or cell phone number)*

Unit Number (if in SaddleBrooke)*

Lot Number (if in SaddleBrooke)*

Email Address (Optional)

Method of Payment*

Check box only if paying by PayPal or credit card

Single Registration $20.00 USD
Household Registration $30.00 USD

Total: $0.00 USD