Volunteer Group or Organization Name (if any) Group/Org Telephone (###) ### #### Number of Individuals Volunteer Name (Last, First) * or Parent/Guardian/Group Leader First Name Last Name Email * Volunteer Phone (from 8am - 5pm) (###) ### #### Date of Birth * MM DD YYYY Emergency Contact and Relationship * Emergency Contact Telephone * (###) ### #### I am available * Year-Round Only during the following: (Example: from April to July) Days/Times most convenient for you Weekdays Weekends Max Time Commitment (hours) Do you have a vehicle and/or equipment you are licensed to operate? Yes No Are you interested in donating project materials, money, etc for IIMD volunteer projects? Yes No If yes, please describe donation How did you learn about IIMD volunteer opportunities? IIMD Staff Family/Friends Social Media Google IIMD Website Another organization Other What type of Volunteer work are you willing and able to do? * Why do you want to volunteer? * Thank you!
