Please Print Legibly!

VOLUNTEER REGISTRY Please Print Legibly! TODAY’S DATE: ______

LAST NAME: ______FIRST:______

MAILING ADDRESS: ______

CITY______STATE______

PRIMARY PHONE: ( )______E-MAIL ADDRESS: ______

DAYS/HOURS AVAILABLE: MON ______TUE ______WED______THUR______FRI ______SAT ______SUN ______

ARE YOU ABLE TO VOLUNTEER 100 HOURS DURING YOUR FIRST CALENDAR YEAR? Y_____ N_____

SKILLS/EXPERIENCE: Microsoft Office? Yes______No______Other:______

I wish to volunteer at the following location:

Sacramento______McClellan______Yuba City______Chico______Redding______Martinez______Oakland _____Mare Island______Fairfield______Dixon Cemetery______

I am interested in the following volunteer positions: (please check all that apply)

Administrative/Office Driver (Transportation Pharmacy Assistant Network, Campus shuttle) Ambassador (Welcome and Emergency Room (Sacramento) Recreational Therapy Parking Lot) (Martinez) Chaplain’s Office (Sacramento) Guardian Angel (Martinez Warehouse (mail delivery and No Vet Dies Alone CREC) sorting) Receptionist Coffee Service Program Information Desk Comfort Cart Mobile Library Service Concierge Services Nursing Services Assistant Other: (Sacramento, escort/PACT)

6/6/14