Brockport Ecumenical Food Shelf

2013 Holiday Basket Program Donor Registration Form

Date:

Contact Name: Mailing Address (optional) Telephone: Email Address:

Name of Organization (if applicable) City/Zip (optional)

Please mark your preferred method of contact: Email Phone

I/we would like to provide baskets for __________ families.

I/we will be able to deliver the holiday basket directly to the familys home. I/we would like a Food Shelf volunteer to deliver the basket to the familys
home. Mail or email to:
Holiday Basket Program Brockport Ecumenical Food Shelf 14 State Street Brockport, NY 14420 Phone: (585) 354-9081 Email: brockportfoodshelf@gmail.com