Millard Fuller Legacy Build - 2012- Henry County Registration

The fourth annual Millard Fuller Legacy Build will be taking place in McDonough, GA, starting Sunday, September 9th with the kick off dinner. The Build days will begin Monday, September 10-14, 2012 starting at 7:30 am and ending each day at 5:00 p.m. Please complete the registration form below and after you hit "submit" it will take you to a secure page to make your payment. You may pay now with your credit card or mark that you will send in your check. It is important that you check your method of payment in order to receive confirmation of your registration. In addition, you will need to send in your Emergency Contact Form and Release Waiver to:
Fuller Center for Housing
MFLB 2012-Henry County
PO Box 523
Americus, GA 31709

Should you have any questions or concerns please contact Brenda Barton at brenda@fullercenter.org.

Last Name: *

First Name (One name only-please register second person separately): *

Email Address: *

Mailing address: *

City: *

State: *

Postal Code: *

Home Phone: *

Cell Phone:

Work Phone:

Year of Birth: *

Gender: *

Female

Male

Occupation:

Name of Group or Team (Optional):

Group or Team Leader (Optional):

Lodging-Please check where you will be staying: *

Host Hotel

Volunteer Lodging-Requested

Other

Lodging Other-If you checked "other" please let us know where you are staying-thank you:

Lodging - Roommate Request (For hotels only):

You may request a roommate if you are staying at one of the hotels and we will try to match you with a roommate.

Arrival Date: *

Departure Date: *

Will you be attending: *

Sunday Kick-off Dinner (Sept. 9, 2012)

Build Day 1 - Monday (Sept. 10, 2012)

Build Day 2 - Tuesday (Sept 11, 2012)

Build Day 3 - Wednesday (Sept. 12, 2012)

Build Day 4 - Thursday ( Sept. 13, 2012)

Build Day 5 - Friday (Sept. 14, 2012)

Friday-Final Celebration Dinner (Sept. 14, 2012)

How are you arriving: *

Driving

Flying

If flying-will you need shuttle service from airport to hotel/or volunteer lodging-if so please list your flight information.:

Skills (Other):

Please describe other skills and/or building experience.

Level of Skill:

none

semi-skilled

very skilled

Bringing:

Will you have hand tools, tool trailer, other? Please let us know.

Pre-Build or Post-Build:

Would you like to participate in pre-build or post-build support? If so please list your available dates and we will put you on the list for notification of all pre-build and post-build opportunities.

Do you have a special diet/or special needs?: *

Please provide us with your local newspaper(s), contact person/reporter, and phone number-we will be using this to help promote the MFLB 2011:

Please check below if you would allow Fuller Center to share your contact information with other volunteers after the event: *