2024 AmeriCorps Commitment to Service Registration

Registrant Information

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* 1. Contact Information

Name (First & Last): *

Host Site: *

Host Site Address: *

Address Line 2:

City/Town: *

State:

ZIP: *

Your Email Address: *

Your Daytime Phone Number: *

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* 2. AmeriCorps Program:


Please select your AmeriCorps Program from the drop-down list:	Please select your AmeriCorps Program from the drop-down list: menu
VISTA	VISTA menu
AmeriCorps Alum	AmeriCorps Alum menu

Other:

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* 3. AmeriCorps Program Director - please enter the name of your AmeriCorps program's Program Director

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* 4. If you require any accommodations to fully participate in this event, please list them here or contact: jamie.mcfaul@maine.gov

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* 5. Do you plan on participating in the service project at Bond Brook?