Neighborhood Food and Fund Drive Captain Sign-Up Form - Regional Food Bank of Northeastern New York

Neighborhood Captains help distribute bags to households on the streets of their choosing. On the morning of May 1, Captains pick up the full bags and bring them to the Regional Food Bank.

Captain Name(Required)

First Last

Organization/Company Name (if applicable)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Choose One

ZIP Code of Bag Distribution Area(Required)

Street Names of Bag Distribution Area(Required)

I will be covering more than one ZIP code

Yes

Please fill out a new registration form for each zip code and corresponding street name(s).

Number of Bags Needed (please round up to the nearest 10)(Required)