2013 Hurricane Sandy Volunteer Application

*Contact's FULL Name Single registration? add contact info here AND registrant info below. Group registration? add group contact here and list individuals below.

*Contact's Email
Thank you for your willingness to volunteer to partner with the survivors of Hurricane Sandy in their recovery efforts here in our conference.

All fields with an asterisk (*) are required. These satisfy the needs for our insurance coverage and our dispatch team.
*Desired Arrival Date Please list the date you would like to arrive on site; use this format: MM/DD/YYYY
*Departure Date Please list the date of departure in the MM/DD/YYYY format
*Proposed Work Days
Volunteers on Your Team
If you are filling out this form and will be volunteering, please be sure to include yourself as the contact above and as a volunteer below.Team Leaders: If all of your team members are returning, you will need to list yourself here and everyone else in the "Returning Volunteers" section below; there must be at least one volunteer in this section.
*First Name *Last Name *Email *Address 1 Address 2 *City *State *Zip
*Daytime Phone
*Evening Phone
Cell Phone
*Gender
*Age
T-shirt size Adult unisex sizes. If you would like to purchase an NYAC recorvery t-shirt for $10/each, please fill in the sizes here. You can enter a different answer for each team member by clicking the box below. Please make checks out to: New York Annual Conference or NYAC/Sandy Recovery and give it to site manager when you arrive.
Returning Volunteers Please list here any volunteers who have previously served at Hurricane Sandy sites; you do not need to fill in all of their information above. This area allows us to understand how many returning volunteers will be joining your new volunteers.
Experience
*Indicate any professional license or specialized certification you hold MD, RN, PE, EMT, LSW, Pastoral Counseling, etc.
*Are you CPR certified?
Yes
No
*Are you UMCOR ERT trained?
Yes
No
*Have you completed VIM Team Leader training?
Yes
No
Special Skills
Please check the special skills you possess and indicate applicable skill level
*Construction
Professional
Excellent
Good
Fair
No
*Electrical
Professional
Excellent
Good
Fair
No
*Masonry
Professional
Excellent
Good
Fair
No
*Plumbing
Professional
Excellent
Good
Fair
No
*Office & Computer Skills
Professional
Excellent
Good
Fair
No

Emergency Contact

*Name
*Address
*City, State, Zip
Email
Cell Phone
*Daytime Phone
*Evening Phone
*Contact's relationship to you
Your NYAC Relationship
Your Church
Please choose your church from the drop-down list:
Pastor's Name
Other Affiliation Including non-NYAC volunteers.
For office use only:
CDAC member assigning this team:
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