City Wide Club: Community Agency Registration

Thank you so much for your Agency participation. Your support is needed. Please complete the information below and submit it to secure your table.

Agency Name:
Contact Person:
Agency Address:
Agency City:
Agency State:
Agency Zip Code:
Contact Phone:
Email Address:
Event Name:
Event Date:
Resources/Services Provided:
Area Served:
How many staff/volunteers are coming with you?
Is this your first time volunteering with City Wide Club? Yes No
How did you hear about us?
Note: We are only able to provide tables and chairs. Equipment or electricity not provided. Agency will assume all responsibility for equipment and supplies.