| * Agency: |
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| * Mailing Address Line 1: |
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Mailing Address Line 2: |
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* Mailing Address City, State, and Zip Code: |
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| * Main Phone Number for Agency: |
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| Fax Number for Agency: |
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| Web Page for Agency: |
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| * Agency Mission: |
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| * Name of Executive Director: |
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| * Name of Volunteer Coordinator: |
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| * Contact Person for Fair: |
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| * Phone Number (and Extension) for Contact Person: |
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| * E-mail Address for Contact Person: |
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| * Nametag for Representative 1 -- Name: |
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| * Nametag for Representative 1 -- Title: |
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| Nametag for Representative 2 -- Name: |
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| Nametag for Representative 2 -- Title: |
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| Nametag for Representative 3 -- Name: |
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| Nametag for Representative 3 -- Title: |
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| We are recruiting for opportunities that are: |
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| These opportunities are: |
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| * Do you require an electrical outlet? |
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