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? CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.