Retired & Senior Volunteer Program
VOLUNTEER REGISTRATION FORM

Name: (Mr., Mrs., Miss)
Email:
Address
City, State & Zip
Telephone # (Including area code)
Date of birth
How did you hear about RSVP? Newspaper  Radio/TV  Friend  Other
Former Occupation
Any disabilities?
Do you currently volunteer? YES  NO  If yes, go to next line.
In which County (or counties) do you volunteer?
Former volunteer experience
Ethnic Group African/American  American/Indian  Asian  Caucasian  Hispanic
Are you a full-time resident of Orange County? YES  NO  If no, go to next line.
In which County are you a resident?
Do you drive? YES  NO
Do you use public transportation? YES  NO
Would you be interested in FREE event tickets? Afternoon only  Evening only  Both
Volunteer: As you sign your name and date
I understand my information may be released to other non-profit agencies, but NEVER for solicitation
DESIGNATION OF BENEFICIARY (REQUIRED)
(For RSVP FREE Supplemental Accident & Liability Insurance)
Beneficiary's Name
Relationship
Address
City, State & Zip
Telephone # (Including area code)
INSURANCE STATEMENT
I understand that if I use my personal automobile in going to and from my volunteer assignment, I will arrange to keep in effect automobile insurance equal to minimum limits required by the State of Florida.
Driver's License Number
Expiration Date
- - - - RSVP USE ONLY BELOW THIS AREA - - - -
Volunteer I.D. Number
Station Assignment
Job Description
Interviewer
Project Director Signature


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For more information:
Retired & Senior Volunteer Program
99 E.Marks Street, #102
Orlando, FL 32803-3847 US
Email: rsvp11@earthlink.net
407 422-1535
Fax: 407 841-2729

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