Name * First Name Last Name Phone * (###) ### #### Stake Ben Lomond Coldwater East Ridge Harrisville Huntsville Farr West Farr West Poplar Mound Fort Mount Lewis North Ogden North Ogden East Orchard Springs Ogden West Plain City Pleasant View Pleasant View South Other Ward Service Date * This is the date you are planning to serve MM DD YYYY Jobs * Youth Night(Wed 6:30-8:00) 8:30-10:30 AM 5:30-7:30 PM For Demo and Testing