Make A Difference Day

October 5, 2007

Sign-up Deadline: September 28, 2007

* You must answer all of these questions.

* Name:

* E-mail Address:


Do you or any member of your group require transportation accommodations (due to any disability or injury)?
Yes
No
If 'Yes', please describe (accommodations needed, number of participants needing accommodation, etc.)

* I would like to volunteer. If 'Yes', please fill out the information below before submitting.
Yes
No

* I am signing up as a:
Student (Individual)
Student Organization
Residence Hall
Staff/Faculty
Community Member

If you selected Student Organization or Residence Hall, please fill out the following two fields. Otherwise, leave these empty.

Organization Name/Complex:

Number Participating:


* I will report to Cravath Lake Park at:
1:00
2:00

* I have a task preference (see choices below):
Yes
No

If you answered yes above, please indicate your first two preferences.

My first choice is:
Departmental Assistance
Project Work (Indoor)
Cleaning (Indoor)
Trash Pickup (Outdoor)
Yard Work
Painting

My second choice is:
Departmental Assistance
Project Work (Indoor)
Cleaning (Indoor)
Trash Pickup (Outdoor)
Yard Work
Painting

* Shirt size I prefer:
Small
Medium
Large
X-Large
XX-Large

Number of shirts needed for my group (only for Student Organizations and Residence Halls). Do not include your own shirt in this count.

Small:


Medium:


Large:


X-Large:


XX-Large:


* I agree to hold harmless the UW Systems, UW Board of Regents, UW-Whitewater, City of Whitewater, and all those participating:
Yes
No