CHANGE 4 GEORGIA MEMBERSHIP APPLICATION Mission: To inspire students to become involved in their communities, and connect them with various community service opportunities. Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent Name (Primary Contact)* First Last Email for Parent (Primary Contact)* Phone for Parent (Primary Contact)*Parent Name (Secondary Contact)*Enter 'not applicable' if necessaryEmail for Parent (Secondary Contact) Phone for Parent (Secondary Contact)Gender*MaleFemaleGrade*FreshmanSophomoreJuniorSeniorIF Teacher*Membership ResponsibilitiesAs a member of Change 4 Georgia (C4G), I will attend, participate, and be respectful at meetings, service projects, fundraisers, and on social media. I will pay a suggested annual donation of $35.00. I will have an interest in serving others. I will be accountable, responsible, and helpful. I will be a good role model and C4G representative. I will have a positive attitude and be supportive of fellow members. I agree to abide by the Membership Responsibilities.*YesNoMembership Fee Price: $35.00 Quantity: Tee ShirtI wish to have an adult size C4G t-shirt for a suggested donation of $20.00.Small (adult size)Medium (adult size)Large (adult size)X-Large (adult size)XX-Large (adult size)Upload Recording Policy*C4G membership requires a signed Recording Policy to be in our files (see URL below). Sign the policy, save to your computer, then upload the file. http://change4georgia.org/join-c4g/recording-policy/NameThis field is for validation purposes and should be left unchanged.