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Recognition Form

Please complete a form for each volunteer you wish to recognize. We would like to invite employers. If this is appropriate, please include the requested information. Thank you. Reservations will be confirmed on receipt of payment no later than Nov.15. Make chekcs payable to the Volunteer Center, 400 W. Fourth St., Suite 200, Winston-Salem, NC 27101.
indicates a required field.

Name of Agency
Agency Representative
Address
Phone Number
E-mail
Volunteer
Area of Volunteer Service
Length of volunteer service
Employer, if appropriate
Employer Address
Employer Phone
Additional Remarks about the volunteer
Would be able to donate doorprize(s)

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