Emergency Volunteer Registration Form

Thank you for your interest in helping the islands in the event of a disaster. We have a long history of islanders helping islanders, and we aim to continue that tradition. Please take a moment to complete the form below. You're not signing up for a major committment, and you're not required to help out. We'd just like to know who is willing to help, and give you some simple instructions on where to go if there's a disaster, and what to bring. We truly appreciate and rely on your help. Thank you.

Please fill in all fields marked with a *
Last Name:
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First Name:
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Email Address:
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Home Phone:
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Work Phone:
Mobile or Other Phone:
Island of Residence:
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Street Address:
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Town:
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Zip Code:
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Do You Have Any of The Following Skills?
Additional Skills 2:
Additional Skills 3:
Do You Have Available Any of the Following Equipment?
Additional Equipment 2:
Additional Equipment 3:
What is Your Current Level of Fitness?
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Do You Have a Current Drivers License?
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Are You an Employee of or Volunteer For:
Are You a:
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Would You Be Interested in Also Helping with Red Cross Disaster Relief Efforts?
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Please list email or phone info for other people who might be interested in volunteering:
Use this space to provide additional info: