A Night in the Country 2013 :: volunteer application

First Name: *

Last Name: *

Mailing Address: *

City: *

State: *

Zip: *

Phone Number: *

Social Security Number: *

Date of Birth: *

Email: *

Occupation:

Returning NIC volunteers, please list previous duties:

Please check the dates you can work:

Please select the time of the day you're able to work:

Daytime

During the Event

Night Time Shifts

No Preference

As a volunteer, you receive one t-shirt: *

Are you over 18? *

Yes

No

Emergency Contact: *

Phone: *

Address: *

Do you have any physical limitations? *

Yes

No

If Yes, what are they:

Please mark the MANDADORY training you plan to attend: *

June 20th @ 1pm

July 13th @ 5pm

July 18th @ 5pm

Please select your preferred job duty:

Please select your second choice job duty:

Please select your third choice job duty:

I want my volunteer hours attributed to:

If Other, please specify:

VOLUNTEER CODE OF CONDUCT *

By clicking here I have read and agree to the Night in the Country Volunteer Code of Conduct.

Please digitally sign this form by typing in your full name: *

volunteer application