Your Name
*
First Name
Last Name
What is your affiliation with the club (Mark all that apply)
*
Founder
Alumni
Alumni Parent
Member
Member Parent
Current or Past Board Member
Current or Former Staff
Current or Past Coach or Refreee
Other
If you marked "Other" please explain your affiliation to the club:
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Years you were affiliated with the club?
Guess to the best of your knowledge please! Example: 2012
From (Year):
*
To (Year):
*
If Applicable- Person you want to refer to us to reach out to:
First Name
Last Name
References Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Honor Our Past
Share a meaningful memory, milestone, or story that reflects our history and impact.
Celebrate Today
Tell us about a current success, achievement, or experience that makes you proud to be part of our organization today.
Build Tomorrow
Share your vision, hopes, or ideas for the future and how we can continue making an impact for the next 25 years.
Do you have pictures or documents that we can use or reference? Upload them below:
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We welcome you to share your story in your own voice - Please record in a quiet space and ensure your microphone is working properly.
Please verify that you are human
*
*
I understand that by submitting this form, I grant the Boys & Girls Club of the Umpqua Valley permission to use my story, quote, voice recording, photos, or other submitted materials for promotional, marketing, fundraising, and storytelling purposes, including the 25th Birthday Bash and future Club initiatives.
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