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One Village One World - Community Interest Form

Please complete the form below and either click the Submit button to send this information to us electronically, or print and mail the completed form to us at:

One Village One World
P.O. Box 250070
West Bloomfield, MI 48325-0700

We thank you for your willingness to make a difference!

*All fields are required
Name:
Name of Group or Community:
Address:
City:
State:
Zip:
Telephone Number:
E-mail Address:
Please enter today's date below in the following format: MM-DD-YY (Example: 11-12-07 * Note: must contain hyphens)