RSVP Volunteer Enrollment Form

Date *

Your Contact Information

Name *

First

Last *

Last

Address *

Address Line 2

City *

State *

Postal Code *

Home Phone *

Cell Phone

Email *

Emergency Conact

Emergency Contact: Include name, relationship, address and phone number. *

Skills, Interest and Background Information

Share with us a little about yourself and why you want to volunteer. *

For example your skills, interests, background and hobbies

Volunteer Placement

List the agencies and the volunteer jobs that you are interested in. Our RSVP Coordinator will contact them on your behalf. *

Are you currently volunteering? Please provide the agency and the position. *

Times Available

Please share with us your time preferences for volunteering or times of the year you know you are regularly out of town.

Designation of Beneficiary for RSVP Volunteer Insurance

As an RSVP member, you are automatically entitled to a $2500 accidental death benefit to the beneficiary of your choice.

Please enter beneficiary information below: *

Address *

If same as your own just right same.

Phone # of Designation of Beneficiary for RSVP Volunteer Insurance *

Relation to you? *

RSVP Auto Libality Insurance Information

State and Drivers License Number. (RSVP Accident and Liability Insurance requires a valid drivers license and liability insurance to be in effect)

Do you drive *

Yes

Take the bus

Driver License #

Exp Date:

Auto Insurance Company

RSVP

Your Volunteer Center for the Second Half of Life