HELPERFlyingSamaritans

Los Amigos Chapter

 

PLEASE COMPLETE THIS FORM.  WHEN YOU "SUBMIT" YOUR PREFERENCE IT WILL BE FORWARDED DIRECTLY TO THE EMAIL OF THE HELPER COORDINATOR.

THIS IS JUST A TRIP PREFERENCE FORM.  CONFIRMATION WILL BE MADE BY YOUR COORDINATOR PRIOR TO THE TRIP.

 

Date of Form Completion: 

 

Name:     

                                                         

Contact Phone Number:     Email:  

 

Primary Choices:      Select as many as apply 

2008-2009 season  (**trip on 1st weekend)

 

October 10-12,2008

March 13-15, 2009

November 7 - 9, 2008

April 3-5, 2009

December 12 - 14,2008

May 1,3, 2009**

January 9 - 11,.2009

June 13 - 15, 2008

February 13, 15, 2009

July 11 - 13, 2008

Secondary Choices:   Select as many as apply

October 10-12,2008

March 13-15, 2009

November 7 - 9, 2008

April 3-5, 2009

December 12 - 14,2008

May 1,3, 2009**

January 9 - 11,.2009

June 13 - 15, 2008

February 13, 15, 2009

July 11 - 13, 2008

 

No Way:  Please do not call regarding this trip

 

October 10-12,2008

March 13-15, 2009

November 7 - 9, 2008

April 3-5, 2009

December 12 - 14,2008

May 1,3, 2009**

January 9 - 11,.2009

June 13 - 15, 2008

February 13, 15, 2009

July 11 - 13, 2008

 

 

 

Use this space for any comments or special requests you would like to make of the Helper Coordinator:

 

 

Thank you for completing this form.  I will be in contact with you prior to the trips for which you have agreed to participate.                                   

                                                                                            Cynthia Russell 

                                           cynrussell@hotmail.com                 

 

Please press the submit button only once.