Project Shalom Form

Full Name*

First Name Last Name

Address*

Phone Number* A good number for text as well.

Area Code Phone Number

E-mail*

I would love to participate!
(check boxes for the following:)

*

I can volunteer once a month I can deliver packages as needed

I would love to donate to help this special program:

1 package: $36 5 packages: $180 10 packages: $360

Other amount

$100 $250 $500 $770 $1000

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates by email

Project Shalom: Join here