35 Cerone Place, P.O. Box 2615, Newburgh, NY 12550Office Hours: Monday - Friday, 9 AM until 12 NoonPhone: (845)-562-3490 Click Here for PDF version First name: * Last name: * Email address: * Address: * City: * State: * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: * Home Phone: * Mobile Phone: Date of Birth: * In case I have an emergency, please contact: Emergency Contact Name: * Relationship to me: * Emergency Contact Phone: * I am interested in volunteering as a (check all that apply): * Driver Kitchen Helper Special Projects How often are you available? (check all that apply) * Weekly Occasionally/Substitute Emergency only What day or days are you available? * Mon Tue Wed Thu Fri Do you have your own car? * Yes No If you will be driving your own car, please give us a copy of both your NYS Driver's License and your current NYS Insurance ID card. How did you hear about volunteering for Meals on Wheels?