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CHYL Membership Application 2015

Camillus House Young Leaders support Camillus House by volunteering their time, talents and energy promoting the organization’s mission by raising awareness and funds through various special events and volunteer activities.

Contact Information

Please Enter Your Contact Information:

First Name
Last Name
Date of Birth
Email
Home Phone
Cell Phone
Address
City
State
Zip
    Please add Me to the Camillus House Mailing List

 

Please check the appropriate information:
Your Sex
 Male  Female
 
Your Background
 American Indian  Caucasian  Asian/Pacific Islander
 African-American  Hispanic  Other
 
Education

Tell us about your Educational Background:
  (begin with the highest level completed)
List name of School/College, Year(s) Attended and Degree
School/College #1
School/College #2
School/College #3
Employment Information

Please Enter Your Employment Information:
   I am presently not employed.
   I am a full-time Student.
Current/Most Recent Employer
Address
City
State
Zip
Areas of Interest

Please Enter Your Areas of Interest:
  I am interested in learning more about CHYL
  I want to get involved in activities such as tutoring and meal service
  I want to help plan CHYL social events to benefit Camillus House
  My company/restaurant/venue would like to host a CHYL social event
  I would like to serve on the CHYL Board of Directors
 

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move


 
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Click here or call us at 305.374.1065 {305-CAMILLUS}
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