Please feel free to add to this list and send back to me.  Michael wants these lists by tomorrow morning..

 

 

Volunteer Information Checklist:

 

First Name:

Last Name:

Company:

Address:

City:

State:

Zip Code:

Office Phone:

Cell Phone:

VoIP Phone:

Email Address:

 

Health Concerns:

 

Medication Allergies:

 

Medication Needs:

 

Insurance Company:

Insurance Company Phone Number:

 

Closest Relative:

Relation:

Address:

City:

State:

Zip Code:

Phone:

Email Address:

 

Skills:

 

Description of Tasks:

 

Description of Locations of Work:

 

Date Work Commenced:

Date Work Ended:

Willing to Return:

 

 

Rick Harnish

President

OnlyInternet Broadband & Wireless, Inc.

260-827-2482 Office

260-307-4000 Cell

260-918-4340 VoIP

www.oibw.net

[EMAIL PROTECTED]

 

 

 

 

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