VOLUNTEER RENEWAL DATA FORM

You may complete this page and send it via email: evelyn@bigriversredcross.org

Or you may complete by hand and mail it to us at American Red Cross – Big Rivers Chapter, P.O. Box 2175, Owensboro, KY  42302.

Name_______________________________________________________ Date______________

Street Address_________________________________________________________________

City____________________ State____ Zip______ County in which you reside______________

Home Tel__________ Work Tel__________ Cell Ph____________ Email___________________

Have you previously used any other name(s) beside what is provided above?________________

If yes, specify___________________________________________________________________

Birthdate (Month/Day/Year): Gender_____________ Female________ Male

Approximate date you 1^st enrolled as a red cross volunteer____________________

*Red Cross Training Courses you have taken:                                                             Month/Yr

______________________________________________________________________________

Are you a Disasters Services Human Resources (DSHR) member?_____

*If so, list the National Disaster(s) on which you have served           DR #          Yr         Where

______________________________________________________________________________

*List any Red Cross Committees on which you have served.

______________________________________________________________________________

*Are your First Aid and CPR courses up-to-date?________ Yes_____ No

*List Life Experience(s) (types of jobs, careers, etc.) that would be an asset to your Red Cross Volunteerism:   

Perhaps your lifestyle has changed. Would you like to become more involved as A Disaster Services Volunteer (being trained to help whenever we have local disasters)? Do you now have the time to become a DSHR member serving on National disasters for as much as a 21-day span away from home?     

Would you like to serve on some ot the current planning committees?_____

Could you help a least 1 day per week in the office?______ How many hours____

We especially need volunteers from Hancock and McLean Counties.

If you have questions about these roles, please call Pearl Nester at 283-2438 or 1-800-621-4982.

Thank you for taking the time to complete this form. You are very important to us!

*Place additional classes, disasters, committees, life experiences, etc., on additional page(s)