Full Name  __________________________________________________________

Mailing Adr  ________________________________________________________

City  ______________________________  St ____ Zip &+4  ________________

Telephone, Day  _______________________  Eve  ________________________

e-mail  _______________________________

School/Job  __________________________________________________________

 __________________________________________________________

Days and Time available ___________________________________________

Do you see this as a one-time or on-going part of your life?

Why would you like to volunteer at The Peace Center?

Do you have any previous volunteer experience? __ Yes __ No

If yes, please tell us about it:

Any other experiences/skills/talents that will be useful here?

What in particular are you interested in helping with?

How did you hear about The Peace Center?