HARRISBURG DISTRICT URBAN WORKCAMP Sun., July 11- Friday, July 16, 2010 VOLUNTEERS IN MISSION (V.LM.) ‘Team Member Application <= Central Pa Conference ‘The United Methodist Church (PLEASE PRINT OR TYPE ALL INFORMATION, YOU ‘MAY USE ADDITIONAL PAPER IF NECESSARY) << SE UNITED METHOOIST VOLUNTEERS 1M MISSION Christian Lovein Action! 1. NAME. FIRST MIDDLE LAST 2, NICKNAME PREFERRED. 3. DATE OF BIRTH 2 4.SEX:M F S.ADDRESS. 6. HOME PHONE, 7. WORK PH: 8. CELL PH. 9. Email 10. HOME CHURCH, L1, PASTOR, 12. CHURCH DISTRICT: 13, OCCUPATION (IF RETIRED. PREVIOUS WORK). ‘or Students Only (must be 14 yrs or ol 14, GRADE COMPLETED AS OF JUNE 2010 15. PARENT OR LEGAL GUARDIAN'S SIGNATURE, 16. EMERGENCY CONTACT PERSON, 17, CONTACT PERSON'S ADDRESS, 18, CONTACT PERSON'S PHONE: HOME, WORK é&/or CELL. 19, LIST LOCAL CHURCH ACTIVITIES & LEADERSHIP EXPERIENCES20. LIST PREVIOUS WORKCAMP EXPERIENCES 21. LIST ANY SPECIAL NEEDS OR LIMITATIONS RELATING TO WORK OR LIVING CONDITIONS, INCLUDING MEDICAL NEEDS. 22. ARE YOU WILLING T0 LIVE AND WORK UNDER CONDITIONS THAT MAY BE UNCOMFORTABLE, UNFAMILIAR, AND REQUIRE FLEXBILITY AND UNDERSTANDING? YES___NO COMMENTS 23, ARE YOU WILLING TO WORK WITH INDIVIDUALS OF VARIOUS SEXES, RACES, AND ‘NATIONALITIES AMD TREAT THEM WITH EQUALITY? YES NO, 24. YOUR INSURANCE CO. ID GROUP ID#. Return this form with payment of: $30 per week — I will be staying overnight ‘$30 per week — I will commute -I will /will not be staying for evening meal $5/day(not full week) I expect to help on Mon Tues Wed Thurs Fri I will /will not be staying for the evening meal the day I work (We ask all commuters to agree to arrive for morning devotions at 7:15 a.m. evening meal is optional Make checks Payable to “CALVARY UMC and note “Hbg District Mission Project” on memo line MAIL APPLICATION & PAYMENT TO: Calvary UMC Attn: Rev. Jeff Fisher 4700 Locust Lane Harrisburg, PA 17109 PHONE 717-545-0021 Email: jefffisher@cpcpastors.org