Enrollment Form

We recruit and refer individuals of all ages for volunteer service in nonprofit and public organizations. If you are interested in becoming an RSVP member, please fill out the form below. Or you could download this form here.
* Indicates A Required Field.
Date Of Birth:*
Applying For:*
RSVP (Age 55 And Over)
Medical Reserve Corps
Community Volunteer (Under Age 55)
Name:*

Phone:*
Address:*
City:*

Zip:*
E-Mail:
Are You Currently Volunteering Anywhere?

Yes

No
Name Of Site(s) Where You Currently Volunteer:

Would you like to be contacted to receive assistance in finding a place to volunteer?

 Yes No

Would you like to be contacted for one day events and short term volunteer work opportunities?

 Yes No

Areas of Volunteer Work I Am Interested In
Accounting & Bookkeeping Habitat Homes Office Work
Animals Health Care One Day Special Events
Bulk Mail Homeland Security Receptionist/Telephoning
Carpentry Host/Greeter At Special Events Sewing/Knitting/Crocheting
Children Safety Festivals Law Enforcement
Coat Check @ Civic Theater Newsletters & Proofreading Tutor & Literacy
Computer Programming Legal Library
Data Entry Music Usher / Tour Guide
Environmental Issues Mentoring Children Web Design
Stage & Museum Exhibit Translator Income Tax Preparation For Low
Construction Language   Income Families

Do you hold any special licenses? (RN, Physician, Dentist, Attorney, etc.) Yes No
If you do hold special licenses, please list them.
Do you speak any foreign languages? (If so, please list)
Emergency Contact:
  Name Phone Number Relationship

During your volunteer time you are covered by CIMA supplemental insurance at no cost to you. Please designate a beneficiary or enter "Estate"
Name: Relationship:
Phone: Address:

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