ViSION PSA participation form

First Name *

Last Name *

NUID *

Phone Number *

Email Address *

What is your preferred mode of communication? *

Phone call

Text message

Email

What dates below are you available from 8AM to 6:30PM? Select all that apply. *

Thursday May 29th & Saturday May 31st

Friday May 30th & Saturday May 31st

Thursday June 5th & Saturday June 7th

Friday June 6th & Saturday June 7th

Thursday June 12th & Saturday June 14th

Friday June 13th & Saturday June 14th

Those selected to participate in the PSA will receive a $50 gift card. Please indicate your preferred choice of gift card. This choice will be honored if you are selected to participate. *

Whole Foods

Husky Dollars

Itunes

What languages do you speak fluently? *

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