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Required fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
Date of birth? *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Last Name *
Mobile Phone *

For example, 123-456-7890
SMS/text messaging: By providing your mobile number and checking the box below, UNITED WAY INDIAN RIVER COUNTY will be allowed to send you SMS (text) messages relating to their volunteer activities. To opt-out, reply STOP to any SMS message OR return to this form and uncheck the box.
Street address *
City *
State *
Zip code *
T-Shirt Size? *
Yes! I would like to receive e-newsletters and updates. *
How did you hear about us? *
Do you have any physical limitations?
Emergency Contact: Name & Phone Number *
Volunteer Interests? *