Form Name
MailChimp Tag
Registration Form
Name of Synagogue / Agency
*
Location / Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Point of Contact Information
Name
*
First Name
Last Name
Email address
*
Confirmation Email
Confirm email address
Phone number
*
Please enter a valid phone number.
Position within Synagogue / Agency
How would your synagogue / agency like to participate in CommUNITY Mitzvah Day? (select all that apply)
*
Promote CommUNITY Mitzvah Day to our congregants
Coordinate our own hands-on service program to be included in the list of CommUNITY Mitzvah Day projects
Please tell us about your hands-on service project for CommUNITY Mitzvah Day:
What is the name of your project?
*
How would you describe your hands-on project?
*
Which organization(s) will benefit from your project?
Which age group(s) does your project target? (select all that apply)
*
Kids/Young Families
Teens
Adults
Seniors
During what time of day will people be able to participate in your project?
Start time
*
End time
*
Approximately, how many people do you expect to participate in your project?
*
SUBMIT
Should be Empty: