<p> New London Public Museum 406 S. Pearl St. New London, WI 54961 920-982-8520 Fax: 920-982-8617 www.newlondonwi.org/museum.htm</p><p>Volunteer Application Name: ______</p><p>Address: ______</p><p>City, State Zip: ______</p><p>Phone Number: ______</p><p>E-Mail: ______</p><p>Birth Month and Day (Optional, for Volunteer Recognition) Month Day When are you typically available to volunteer? Monday Tuesday Wednesday Thursday Friday Saturday Special Events AM PM</p><p>How often would you like to volunteer? Weekly 2x per month Monthly As needed</p><p>Volunteer Opportunities (please circle 1-2 areas of interest) Research Help the Assistant Director with information requests, archival projects, etc. Training provided, some computer skills needed.</p><p>Education Help the Program Coordinator with adult, family and student educational programs both in the museum and through outreach. Some teaching skills or experience needed.</p><p>Museum Sitting Act as a staff person and take care of the museum occasionally, some Saturdays are involved and training is provided.</p><p>Events Assist staff with special events</p><p>Exhibits Help build things needed for exhibits. Handyman skills required</p><p>Do you have any special skills, experience or interests? (i.e. computer skills, public speaking, foreign language, special areas of knowledge or interest) Please list. ______</p><p>Please provide 2 references (work or personal): Name: Name: Company/Relationship Company/Relationship: Phone Number: Phone Number: What did you do here? What did you do here? </p><p>I certify to the best of my knowledge, that all information given by me in this application and in any other forms I complete during the application process is true and correct. I understand that false or misleading statements made by me or consequential omissions of any kind in the application process, are sufficient cause for not being accepted as a volunteer or for being dismissed if I am already a volunteer no matter when discovered. </p><p>I authorize the New London Public Museum to investigate all of the information contained in this application. Any persons or organizations name are authorized to provide information regarding my employment, volunteer history, character and qualification and they are hereby released from all liability for providing such information. I give the New London Public Museum permission to conduct a background check on myself. I understand that all information will remain confidential; and will not be shared with any other organization or individual. </p><p>I understand that there will be an interview prior to my being accepted as a museum volunteer and I will be expected to complete the required training for museum volunteers, if any.</p><p>By signing this agreement, I acknowledge that I have read it in its entirety, have given the terms due consideration, understand the terms and understand that I am freely and voluntarily giving up certain rights. I further intend that this agreement shall be binding upon all of my successors, heirs, assigns, receivers and the like.</p><p>Signature Date </p><p>Date Guardian Signature (if you are under 18, you must have a guardian’s signature)</p>