PACCAL Membership Form
Fill out the form carefully for registration
PART 1: DEMOGRAPHIC INFORMATION
Name
*
First Name
Last Name
E-mail
*
Please provide your active email address for communication and updates. example@example.com
Mobile Number
*
Enter a phone number where we can reach you for important updates or follow-up communication.
Format: (000) 000-0000.
Birth month/day
*
Only for birthday greetings (MM/DD) (NO Year)
PART 2: ORGANIZATION OPERATIONS
Select Area(s) Where You Can Help (You may select more than one)
Jersey City (Hudson County)
Queens (Queens County)
Zoom (Online)
Staten Island (Richmond County)
Other
COMMUNICATIONS
*
Rows
Yes
No
Opt In for Text Reminders on Upcoming Events
Allow Membership to be Visible in Public
Allow to be Greeted Publicly during Birthday
PROGRAMS
*
Rows
Be a Volunteer
Be a Mentor
Be a Sponsor
Youth Engagement
Senior Programs
New Immigrants Program
Members Program
Health & Wellness
Cultural Activities
Advocacy & Community Organizing
Education & Training (e.g., ESL, Citizenship, Job Prep)
Volunteering at Events
OPERATIONS
Rows
Be a Volunteer
Be a Mentor
[Healthy Heart] Workshop Presenter via Zoom
[Healthy Heart] Administrator via Zoom
[Social Media] Posting
[Social Media] Posters and Design
SUGGESTIONS OR COMMENTS
Collecting innovative ideas and proposals for future programs that align with our mission, address community needs, and promote engagement, growth, and impact. Or use this as an open space for any extra thoughts, feedback, or suggestions not covered in the previous sections.
PART 3: CONFIRMATION
Take Photo
I understand that by signing this form, I agree to support the mission and values of PACCAL, and will follow the organization’s code of conduct as a participating member.
Print Form
Save
Submit Application
Clear Form
MEMBERSHIP APPLICATION PROGRESS
Rows
Submitted
Reviewed
Dues Paid
Confirmed
STAGE
DATE
DUES INFORMATION
Rows
1
2
3
4
5
AMOUNT
RECEIVED
EXPIRATION
Membership Expiration
-
Month
-
Day
Year
Date
Form Updated
-
Month
-
Day
Year
Date
Should be Empty: