HHI Form | Healing Hands International

Name *

First Name

Last Name

Organization Type

Organization Name

Address *

Street Address

City

State

Zip

Email *

Email

Phone *

Phone Type

Mobile Phone Number

Home Phone Number

Business Phone Number

Fax Phone Number

Do you text? *

Yes

No

Are you able to stand 4-6 hours at a time? *

Yes

No

Can you lift up to 20 pounds? *

Yes

No

Other info you would like us to know (particular skillsets, additional availability, etc.)