Volunteer Membership
VOLUNTEER
MEMBERSHIP APPLICATION
Name__________________________________________ Age________
Address____________________________________________________
Street City State Zip Code
Home Phone____________________ Cell Phone____________________
Email______________________________________________________
Church You Attend_____________________ Conference_____________
Phone________________ Email________________________________
Pastor's Name_______________________________________________
Phone_______________________ Cell Phone____________________
Email______________________________________________________
Emergency Contact Person:
1. Name___________________________________________________
Phone_______________________ Relationship_____________________
2. Name___________________________________________________
Phone_______________________ Relationship_____________________
Membership Dues (ENCLOSED):
New Members ($35) $
Renewals ($20) $
Send to:
The Harvest Connection Disaster Relief Center
2600 W. Vernon Ave.
Kinston, NC 28504
(252)526-9908
