Purple Dragon Co-Op Coordinator signup form

We will contact you as soon as a position becomes available in your area.

First Name (required)

Last Name (required)

Street Address (required)

City (required)

State (required)

AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingDistrict of Columbia

Zip Code (required)

Primary Phone (required)

Secondary Phone

Your Email (required)

I would Like to: (required)

Start a new groupCoordinate an existing groupEither

I am interested in being a: (required)

Admin and site host ($40 discount per delivery)Admin only ($20 discount per delivery)Site host only ($20 discount per delivery)Any of the above

Are you familiar with how we work?

Have you been a member of one of our groups or tried shares?(required) *

We find that potential coordinators who have tried us out, are more committed and are more effective coordinators.

Yes, I was a member for more than 3 deliveries.Yes, I have tried at least 1 share.No. I have never tried a share or been a member in a Purple Dragon Group.Other

Have you visited our website or Facebook page to learn more about us?(required) *
There is lots of information about us on these sites. Please read through the information to learn more about us.

Yes I have visited PurpleDragon.comYes I have visited the Facebook Page.No. I have not visited either of these sites.Other

Where do you want to start a group?

Please, provide address if different from your home address.

Which Purple Dragon pickup point would be closest to your desired group location?(required) *

AllendaleAtlantic HighlandsBasking RidgeBayonneBayvilleBelvidereBlauveltBloomfieldBoontonBridgewaterEatontownFair LawnFlandersGlen GardnerGlen RidgeHainesportHamburgHastings-On-HudsonHighland ParkJersey CityLeoniaLincroftLyndhurstMadisonManahawkinManasquanMaplewoodMilford, PAMillburnMontclairMontroseMorris PlainsMorristownNewarkNew City, NYNewtonNorth PlainfieldNyackOakhurstPearl River, NYPoint PleasantPompton PlainsRidgewoodRiver EdgeRiver ValeSouth OrangeSuccasunnaSummitUnionWallWayneWeehawkenWestfield

At my desired group location I have a: (required)*

Check all that apply

PorchGarageBasementOther

I can coordinate a group with a delivery day on a:(required) *

WeekdayWeekendEither

How soon could you start?(required) *

Date is entered in YYYY-MM-DD format.

Who will divide for your group? *(required)

(Dividing earns $30 per delivery and may be shared by several people.)

Rotating group members (most common in a Saturday group)MyselfA partner coordinator

If there will be a single divider, who will be the backup divider?

Do you have people in your area who want to join Purple Dragon? (required)*

YesNo

If you answered "yes" to the last question, how many people do you have? Other then you. (Number only please)

If you want to share the job, do you have someone who will be your partner coordinator?

If you answer "yes" to this question, please move on to the partner coordinator section.

YesNo

If you will not be sharing the job, who can be your backup whenever you are away or otherwise unable to host?

Your backup's email address

Your backup's phone number

Partner Coordinator Information

If you answered that you have a partner coordinator to share the job with, please answer the following questions about that partner.

First Name

Last Name

Street Address

City

State

AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingDistrict of Columbia

Zip Code

Primary Phone

Secondary Phone

My partner coordinator has a:

Check all that apply.
PorchGarageBasementOther

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