PACCAL Form

PACCAL Membership Form

Fill out the form carefully for registration
PART 1: DEMOGRAPHIC INFORMATION
Name

First NameLast 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)

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.

MEMBERSHIP APPLICATION PROGRESS

Rows	Submitted	Reviewed	Dues Paid	Confirmed
STAGE
DATE

DUES INFORMATION

Membership Expiration

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Form Updated

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

PACCAL Membership Form