Nickels For Nails Registration

This is to be used as the registration for your school or organization to participate in the Nickels for Nails Fund-raising Drive.

If you have any questions please contact, mission@habitatsect.org or 860-442-7890 ext 201.

Question Title

* Information of School / Organization that will be participating

Name: *

Address: *

Address 2:

City/Town: *

State:

ZIP: *

Email Address: *

Phone Number:

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* Grade Level

Elementary School (K-5)

Middle School (6-8)

High School (9-12)

College

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* Adult Leader Information
(there must be an adult from the school or organization that is willing to be the primary contact person for the event)

Name:

Email Address:

Phone Number:

Question Title

* Adult Leader's Position

Teacher

Club Advisor

Youth Group Leader

Coach

Faculty

Other

Other (please specify)

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* Student Leader Information

Name:

Email Address:

Phone Number:

Question Title

* Student Leader Information

Name:

Email Address:

Phone Number:

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* What year will you being doing the drive?

2010

2011

2012

2013

Question Title

* Information of School / Organization that will be participating

Question Title

* Grade Level

Question Title

* Adult Leader Information (there must be an adult from the school or organization that is willing to be the primary contact person for the event)

Question Title

* Adult Leader's Position

Question Title

* Student Leader Information

Question Title

* Student Leader Information

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* What year will you being doing the drive?

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* How do you plan to run the drive in your school, congregation or community?

* Adult Leader Information
(there must be an adult from the school or organization that is willing to be the primary contact person for the event)