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Harvest Hand Interest Form
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* Indicates required question
Email
*
Your email
First and last name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Phone number
*
Your answer
Address (Street, City, State, Zip)
*
Your answer
I have an interest in: (can select multiple)
*
Front Desk
Scanning and Filing
Nurse or Medical Provider (Doctor, PA, etc)
Spiritual Care
Church Liasion
Medical Billing/Accounting
Administration
IT Services
Board development
Other:
Required
What is your availability?
*
Your answer
How did you hear about us?
*
Church
Flyer
Our website
Another Harvest Hand
Other:
Thank you for your interest.
If you do not hear from us within a week, please call the office at 630-734-0580 or send an email to
cornerstonefamily@yahoo.com
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