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CRCAA Membership Form
Thank you for becoming a member of the Cody Rouge Community Action Alliance CDC!
We will send you a confirmation email after we process your form. If you have any questions, please email:
rbare@codyrouge.org
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* Indicates required question
Your first and last name
*
Your answer
Age range
*
19-24
25-35
36-59
60+
Other adults in household? If yes, please include name and age range.
Your answer
Address, City, State, ZIP
*
Your answer
Phone number
*
Your answer
E-mail address
*
Your answer
Are there children in the household? If yes, please include names and ages.
Your answer
Race/ethnicity (CRCAA is open to people of all backgrounds and does not discriminate. However, many of our programs are asked to report this data anonymously as part of their funding requirements.)
*
African American
Arab American
Asian American
Caucasian
Hispanic/Latinx American
Native American
Multiracial
Other:
Affiliation to Cody Rouge
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Resident
Church
Organization
Business Owner
Other:
Are you interested in volunteering?
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Yes
No
If interested in volunteering, what types of projects?
Neighborhood Cleanup Projects
Civic Engagement
Events
Block Captain
Providing a Professional Service
Home Repair
Youth Council
Door to Door
Phone Bank
Other:
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