Become a Board Member WIND,CDC Board Member Registration Form About meAll fields marked with * are required and must be filled.Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Name Last Name Address* Street Address Street Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State / Province Postal / Zip Code Contact number*Days available to volunteer* I am over 18* Yes No Date of Birth* MM slash DD slash YYYY I am a 38109 resident or have connections to the WIND community* Yes No I have a drivers license* Yes No My InterestsMy main areas of interests are:I can offer the following skills, knowledge and expertise:I am interested in volunteering in the following role(s):My reason for getting involvedPlease tell is what you hope to gain from volunteering with us: Move the mission forward Volunteer experience Share skills and resources Meet new people Empowerment Opportunities Regenerative community skills Fundraising experience Internship Experience Other My referencesSubmitting references helps us to ensure that the volunteering role is right for you. Please provide details of two references who are over 18. One should be someone you know in a professional capacity, whilst the other can be a neighbor, friend or colleague.Name Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Name Last Name Relationship to you Address Street Address Street Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State / Province Postal / Zip Code Name First Last Relationship to you Address Street Address Street Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State / Province Postal / Zip Code Contact numberEmail Name Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Name Last Name Relationship to you Address Street Address Street Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State / Province Postal / Zip Code Contact numberEmail example@email.comMy Emergency ContactPlease provide the details of someone we can contact in the unlikely event of an accident or illness while volunteering for WIND,CDC.Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Name Last Name Relationship to you* Contact number*Mobile number*Access requirements / health conditionsIf you have any particular access requirements or health conditions (eg medication or allergies etc) that we should be aware of, please state:Contact Permission Please tick this box if you would be happy to hear from WIND,CDC. I am permitting WIND,CDC to contact me by email. My details will not be used outside the organization. My email address is: Thank youfor your interest in volunteering with WIND,CDC. If you have any current convictions, we may ask you to declare them. If you are interested in a role that involves volunteering with children and/or vulnerable adults, we will ask for information about current and/or prior criminal convictions. Having a criminal record will not necessarily exclude you from volunteering with us. CAPTCHA
