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Volunteer Housing Registration Form
(Please print clearly or type)Name of School/Organization: ______________________________________________________________________________________ Contact Person (s): ______________________________________________________________________________________________
(First Name)(Last Name)(PreferredName)
School/Organization Address: _____________________________________________________________________________________
(Street) (City) (State)(Zip)
Email: ________________________________________________ Website: ________________________________________________ Office Phone: (_____) ______-_________ Cell: ( ) _____- ______ Fax (_____) _______- ________ Number of Chaperones Attending: ______ Number of Students Volunteering: _________ Names of Chaperones:1)__________________________2)______________________________3)______________________________ Check One:
COST# OF NIGHTSAMOUNT
Faculty/Staff $20 ________$ ________
Student/Adult $15 ________$ ________
TOTAL:
$ __________
Cancellations and Refunds:
Housing fees will be refunded if cancellation is received in writing nolater than 7 days prior to arrival date. After that date, registration fees are non-refundable.
PAYMENT METHOD
Please remit payment by Checks payable to:
Lower 9
th
Ward Village Community Center.There will be a $25.00 fee charged on checks returned by the bank due to insufficientfunds.Please mail completed registration form with payment to:
Joe McClendon1001 Charbonnet StreetNew Orleans, LA 70117Phone: (504) 304-7868Email:
Joemack107@yahoo.com Please briefly describe your organization and services below: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ______________________________ Please fax completed form to 504-620-9654 by March 5, 2010. You can also mail the form to 2322Canal St., New Orleans, LA, 70119, or email it toamcconduit@urbanleagueneworleans.org. For anyquestions, please call 504-620-2332.
Lower 9
th
Ward Village Community Center
1001 Charbonnet StreetNEW ORLEANS, LA 70117 TEL: (504) 304-7868Email: lower9thwardvillage@gmail.com* Website:
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