Medical Reserve Corps
Volunteer Registration

President George W. Bush created the USA Freedom Corps to foster a culture of service, citizenship and responsibility. This effort builds on the outpouring of support in the days following September 11.

The Medical Reserve Corps (MRC), a component of the USA Freedom Corps, is one way in which health professionals can volunteer to strengthen both our community and our nation. The MRC will consist of volunteers who can assist in our community during large-scale emergencies, such as severe weather, an influenza epidemic, a hazardous material spill or an act of terrorism. MRC volunteers can also work together to improve the overall health and well being of their neighborhoods and community through education and prevention.

To volunteer, please complete this information: (*Please be sure to include your E-mail address.)
Name: Title: First: MI: Last:
Date Of Birth: / /
Home Phone:
() -
Pager:
() -
Work Phone:
() -
Cell Phone:
() -
Fax:
() -
HOME:
Address1:
Address2:
City: State: Zip:
County of Residence:
WORK:
Employer:
Address1:
Address2:
City: State: Zip:
PROFESSION:
Nurse: / Physician Asst: / Paramedic: / Adv. EMT: / Dentist: / Doctor:
Other:
 

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