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  LUNCH BREAK DRIVE REGISTRATION FORM

      Thank you for your interest in organizing a Drive to benefit Lunch Break.

Types of Drives:

Millie Jeter (Food Drive Director): email www.mjeter@lunchbreak.org or 732-747-8577 x 3102

Melia Owens (Program Coordinator): email www.mowens@lunchbreak.org  or 732-747-8577 x 3022

To have any request for written acknowledgement of community service hours you must register your drive in advance and a copy must be submitted to Peg Rizzo at prizzo@lunchbreak.org.

Contact Information

Organization:                _____________________________________________________________________
(if Applicable)

First Name:                 _________________________    Last Name:       _____________________________

Street #:                 ________        Street name:         _____________________________________________


City:                        ____________________________         State: _______   Zip Code: _____________


Email address:        _______________________________________________________________

(please print)

Phone #: Private:         ________________________                Business:        __________________

Drive Information                                        

Today's Date:                   _________________        

 Drive Date:     Start:        _________________   End:        _________________ If applicable


Requests:        Lunch Break tour:                         YES _____ / NO _____

                Speaker:                                 YES _____ / NO _____

Date you deliver your donations: _________________Time:_______________

Thank you for including transportation                                            

Internal Purpose

   Food Weight

                                     

Number of hours worked on the Drive                _______________________

121 Drs. James Parker Boulevard / PO Box 2215 / Red Bank, NJ  07701

Phone: 732 747 8577 / Fax 732 383 8032)

www.lunchbreak.org