Contact Information

First Name:*	Last Name:*
Spouse's Name:
Primary E-mail:*	Secondary E-mail:
Home Phone:*	Work Phone:
Cell Phone:
Street Address:*
City:*	State:*	Zip:*

Ambassador T-Shirts

We will include two Pine Cove Ambassador t-shirts for you and your spouse as a small token of our appreciation.

Shirt Size:*

Spouse's Shirt Size:

Ways to Help

I am interested in:

Organizing a backpack flyer distribution at my child's school.
Hosting a small group at my house and sharing about Pine Cove.
Working a camp fair with our staff and telling other parents about camp.
Using my blog to share Pine Cove stories and pictures with other parents.
Making an announcement at my church or Sunday school class.
Passing out brochures and/or DVD's to my friends and family.
Other:

Sign me up! I'm ready to become a Pine Cove Ambassador.

* = Required field.