Lunch Break Donation Registration Form
Thank you for your interest in organizing a Drive to benefit Lunch Break. Please consider using reusable cloth shopping bags
when collecting towards your drive.
In order to receive Community Service credit, all drives MUST be approved by Millie Jeter prior to completing this form.
Please contact Millie Jeter at Mjeter@lunchbreak.org or 732.747.8577 ext.3102
Type of Drive *
For Further Information, Please Contact:
Millie Jeter for Food, Toiletry & Goodie Bag Drives: mjeter@lunchbreak.org or 732-747-8577 ext. 3102.
Melia Owens for All Other Drives: mowens@lunchbreak.org or 732-747-8577 ext. 3022.
Community Service Hours
In addition to completing this form, you must also complete the volunteer link below so that you are a registered volunteer in our database.
https://creator.zoho.com/vanderven/public/#Form:Contact_Information

Contact Information
Organization (if applicable)
Your answer
First and Last Name *
Your answer
Street Address *
Your answer
City & State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Drive Information
Drive Start Date *
MM
/
DD
/
YYYY
Drive End Date
MM
/
DD
/
YYYY
Requests
Lunch Break Tour
Speaker at Drive
Date you will deliver your donations
MM
/
DD
/
YYYY
Time you will deliver your donations
Time
:
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