(310) 695-7030 (310) 695-7030 VOLUNTEER DONATE Home Key Issues Aging Loneliness Transportation About Mission Community Benefits Service Area Team Board Join Media Events Contact COVID-19 Home Key Issues Aging Loneliness Transportation About Mission Community Benefits Service Area Team Board Join Media Events Contact COVID-19 Friend Application Form WPV Friend Application Form To be completed by those who wish to become a Friend of the Village! Step 1 of 4 25% Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Secondary Phone Save and Continue Later How did you hear about Westside Pacific Villages?*Emergency Contact #1:*First NameLast NameRelationshipEmail (if none, put N/A)PhoneEmergency Contact #2:First NameLast NameRelationshipEmail (if none, put N/A)Phone Save and Continue Later Friend of the Village InformationAs a friend of the Village, you are supporting the great work that we are doing and will receive updated and important information about the Village. You will also have an opportunity to join social activities or share you skills to create new social groups. Please select all that apply: I am interested in participating in social programs and social events I would like to volunteer my skills and/or start a new social activity I am not interested in volunteering or going to the social activities, but am passionate about helping the senior community and want to financially support the Village and its efforts! I am interested in participating in the following activities: Arts and Crafts Canasta and Board Games Fitness Walk and Talk Knitting and Needlecraft Circle On the Move Riders Club (Public Transit) Potluck Brunch I am interested in another activity (Please specify below) Interest finderPlease let us know if you have special skills or areas of interest you would like to share. Save and Continue Later * By selecting this box, I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal, if discovered, at a later date. Name of Applicant*By typing my name below, I hereby agree to all of the statements above.Today's Date*EmailThis field is for validation purposes and should be left unchanged. Save and Continue Later Copyright © 2020 Westside Pacific Villages | Website by Spotlight Story Productions, LLC.