Participants Enrollment Form

Bold Items are Required

NPO Number: Help?

Card Number: Help?

Club Card Holder's First Name:

Club Card Holder's Last Name:

Street Address:

City:

State: CA

Zip Code:

Email:

Confirmation Email:

Home Phone:

 

All information provided to Ralphs Grocery Company ("Ralphs") on this page has been provided to Ralphs in accordance with Ralphs' Terms and Conditions for its Community Contributions program and will be held by Ralphs in accordance with it's privacy policy. Neither the information nor the record of the products purchased by the above named person will be sold or disclosed to any third person. The Participant agrees to indemnify Ralphs in connection with any unauthorized disclosure or use of the Information by the Organization, its representatives or its participants.