Recipient

Recipient Sign-up

Name *

First Name Last Name

Name of person filling this form out *

Self

What type of "Buddy" would you like (check all that apply):

Phone Buddy - phone chats, check-ins, and online ordering support Tech Buddy - provide phone tech support for Zoom, basic smart phone questions, online orders, etc Meals/Grocery Buddy Transportation Buddy

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Year of birth *

Is there anything about yourself that will be helpful to know as we match you with a buddy?