Contact Name* First Last Email* Phone*Best way to contact you? What are you inquiring about?I have a question/commentI want to volunteerI want to take a tourI want to request a speakerI want to become an Agency PartnerI have food to donateI want to know more about financial donationsI need helpQuestion/Comment:Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Birthday Month Day Year If your volunteer hours are required, please indicate who is requiring you to complete hours: Court Workfare School Church Not Required How often would you like to volunteer? One-time Monthly Weekly Varies What days of the week and time of day are you interested in volunteering? Monday (8-12) Monday (1-4) Tuesday (8-12) Tuesday (1-4) Wednesday (8-12) Thursday (8-12) Thursday (1-4) Friday (8-12) Friday (1-4) Past Occupations (Optional)Special interests or abilities (Optional)Working directly with clients, helping with administrative duties, fundraising, working with others, etc. Are you able to lift 40 lbs? Yes No Do you have any physical limitations? Is there anything you are unable or unwilling to do? Has your driver’s license ever been suspended or revoked in any state in the last three years? Yes No If you answered Yes to the previous question, please provide a brief explanation Emergency Contact InformationName, Relationship, Phone How did you hear about volunteering at Weld Food Bank? (Optional) Agreement*I give Weld Food Bank full permission to copyright and/or use, reuse and/or publish and/or republish pictures or images of my volunteer time for the purpose of illustration, advertising, promoting or for any purpose Weld Food Bank deems appropriate, through any medium. I understand Weld Food Bank has the right to change or alter this material. I agree Is this for a business, church or other group? If so, what is the name of your group? How did you hear about us? Is this for a business, church or other group? If so, what is the name of your group? Date MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM How did you hear about us? Any special instructions regarding your venue, group, etc.?Name of your 501(c)3 nonprofit Town you/area you serve What services to you provide?Why do you want to become an agency partner?Town/area you are located What are you looking to donate? Do you need it picked up?Please provide a brief explanation of your inquiryPlease use the following links: Find Food Near You Access a Food Program Address: 1108 H Street Greeley, CO 80631 Phone: 970-356-2199 Fax: 970-356-2297
