Application for Task Force Participation

Date:

Name:

Address:

Telephone:    __________________ (Home)

                    __________________  (Cell)

                    __________________  (Work)

eMail:    _______________________________________

Place of Employment:

Task Force applying for: (May check only one.)

      -     Prayer Task Force

      -     Anti-Drug Task Force

      -     Prevention/Education Task Force

      -     Awareness/Media Task Force

      -     Rehabilitation Task Force

      -     Youth Task Force

Why You Want To Serve On This Task Force? (be as brief as possible):

Print Your Name:  ________________________________________

Your Signature:    ________________________________________

Church Attending:  _______________________________________

Your Pastor's Recommendation:

Pastor's Signature:  _______________________________________