Joining a Care Team and providing monthly support to an AssistHers client.

Providing transportation for a client.

Joining a Committee:

Office

Volunteer Services (Recognition & Retention)

Attending AssistHers Inservice Presentations at 10:30 a.m. on the 2nd Saturday of each month. Please send me the lists of speakers to the address listed below.

Event:

Date:

* Last name:

* First name:

Middle Initial :

Address :

Address (cont.):

City:

State:

Zip/Postal code:

Home Phone:

Work Phone:

Pager #:

Mobile # :

* E-mail:

Referred by: