Volunteer Information Form

Volunteers are an integral part AEMBA. To help us better accommodate your time and efforts, please fill out each section of this form as completely as possible and return it to us.

Full Name: _________________________________________Date of Birth:_____________________

Address: Street:_________________________________________________________________

Town:_____________________________

State: ____________________________Zip:_________________________________

County: __________________________

Telephone: Home: __________________________ Work:______________________________ Fax:______________________________

Internet: E-Mail:__________________________________________________________________Web:____________________

Reasons for Applying:

__ Personal Enrichment; ___Resume Building; ___Community Service; ___Future Employment; ___ Job Reference;

___ Helping the Environment; ___Skill Building; ___Meeting New People; ___Other _____________________________.

When:

1) I would like to help (check one): ___2-3 times a week; ___ once a week; ___

every other week; ___once a month; ___ as needed; ___ unsure

2) What time of year? Winter (WIN) Spring (SPR) Summer (SUM) Fall (FAL)

3) Days Available? Monday (MON) Tuesday (TUE) Wednesday (WED) Thursday (THU) Friday (FRI) Saturday (SAT) Sunday (SUN)

4) Duration of time you plan to commit: __open; __3 months; __6 months; __9 months; __1 year; __other: _________

Where:

5) How would you like to work? Inside (IN) Outside (OUT) Either (IN) (OUT)

6) Would you car pool? Yes (POOL) No

7) Which county’s would you work in?

8) Interested in a particular AREA? Name it here___________________________________________________________________

What:

9) Please list skills, experiences, and equipment you would be willing to use.

10) Personal equipment you would be willing to make available for a work day:

Axes (AXE)

Canoe and/or Boat

Chainsaw

Climbing Gear (GEAR)

Cordless Drill

Pickup Truck

11) Please elaborate on any of your specific interests. What are you most interested in contributing as a volunteer?

__________________________________________________________________________________________________

Signed: ___________________________________________________ Date: _____________________

We look forward to working with you.