Chapter Membership Form

First Name *

Last Name *

Email Address

Phone Number

Number of hours available to volunteer (weekly)

Days of the week available to volunteer
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

How did you hear about us?

Please specify name if needed

Are you under 18 years old? *

Why do you want to volunteer at Bright Mind?

Address Line 1

Address Line 2

City (not required but very helpful if you can add)

State *

Zip Code

Country

By signing below I agree to be a volunteer member of Bright Mind and to uphold the chapter’s regulations and values (brightmindenrichment.org/about-us/), as may be amended or updated from time to time in Bright Mind’s sole discretion.

Signature (If minor, Guardian's signature) *

Name *

Date of Signature *

Comments. Please add more information about how you heard about us.

To be able to keep offering chapter membership without charging (as we do) and helping people as much as possible, we need support from everyone able to donate! If you can donate $10, that will cover minimal costs for yourself for a year. $20 will provide for a member in need, too. $200 will cover minimal funding for an entire chapter for a year. Please donate at https://dev2.brightmindenrichment.org/support-us/. Thank you!

You can submit this form or for any other help in filling the form, please email us at: [email protected].