YES! I am interested in becoming a Committed Partner (mentor) to a youth.

YES! I'd like to volunteer for other activities needed in the program.

YES! Please invite me to your next informational or fundraising event.

YES! I want to know what's happening and how I could be of further assistance.

YES! Please put me on the mailing list and keep me updated.

Name:

Street Address:

City:

State:

Zip Code:

Please call me to discuss how I can serve Committed Partners for Youth
Preferred time to call (please specify days or evenings-do not use periods/dots):

Daytime Telephone:

Evening Telephone:

Fax:

Email:

How did you hear about CPY?

Comments: Please tell us a little about yourself; your business, organization, or association; perhaps a specialty or any other skills and interests you would like to share.

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