For a printable version click here (requires Adobe Acrobat Reader) Fields marked with an * are mandatory
*First Name: *Last Name:
*Mailing Address:
*City: *State: *Zip:
Phone #: *Daytime: Evening: Fax:
Email Address:
Best time to contact you:
Church affiliation (if any):
Occupation or name of school if student:
Organizational or civic affiliations:
Do you own a truck/tools or other equipment that might be useful to Habitat? Please specify:
Check if you would be willing to serve on the board of directors or one of the listed committees:
SKILLS YOU WOULD LIKE TO SHARE WITH HABITAT 1 = highly skilled (professional) 2 = semi-skilled 3 = willing to learn
Click the Submit Button to send your information to CCHFH. Use the Reset Button to clear your information or to start over.
