Become a Volunteer – Bluegrass Military Affairs Coalition

Volunteer Registration Form

PERSONAL INFORMATION

First Name

Last Name

Branch

Active

Retired

Rank/Title

Organization/Business/Government

Address

City

State

Zip

Phone (days)

Phone (evening)

Fax

Email Address

Preferred Method of Contact:

Phone

Fax

EDUCATION

Area of Study:

Professional Degree:

SPECIAL INTERESTS / TALENTS / HOBBIES

Please list activities you enjoy that may help us in placing you in a volunteer role with BMAC (i.e. Photography, Computer Programming, Golf, Cooking, etc.)

Special Interest1

Special Interest2

Special Interest3

Special Interest4

Special Interest5

CURRENT EMPLOYMENT INFORMATION

Job Title/Occupation

Company Name

Company Address

City

State

Emergency Contact Name (We will contact this person in case of emergency while you are volunteering for BMAC)

Relationship to Volunteer

Phone Number

Do you have any health issues that might affect your ability to form certain types of work?

Yes

If Yes, please specify in the space below health issues:

RELATED ORGANIZATION

Related Organization1

Related Organization2

Related Organization3

VOLUNTEER INTEREST

I am primarily available to volunteer during these times:

Mornings (8am-Noon)

Afternoons (Noon-5pm)

Evenings (5pm-9pm)

Waiver

I hereby verify that to my knowledge the above information is accurate. I recognize that as a BMAC volunteer, I am a representative of the Bluegrass Military Affairs Coalition and I will follow the guidelines set forth by the said organization.I wish to volunteer for the Bluegrass Military Affairs Coalition ("BMAC"). I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY PERSONAL INJURY AND/OR PROPERTY DAMAGE THAT I SUSTAIN OR CAUSE DURING MY PARTICIPATION AS A VOLUNTEER. IN ADDITION, I HEREBY RELEASE, HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST BMAC AND ANY OF THEIR EMPLOYEES, VOLUNTEERS, PARTNERS, AGENTS, SPONSORS, BOARD MEMBERS AND SUCCESSORS FROM ANY AND ALL LOSS, LIABILITY OR CLAIMS I MAY HAVE ARISING OUT OF MY SERVICE AS A VOLUNTEER.

I understand that as a volunteer, I may become privy to confidential information about the Bluegrass Military Affairs Coalition. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about the Bluegrass Military Affairs Coalition internal procedures, business operations, personnel information and the like that is not otherwise publicly disclosed by the Bluegrass Military Affairs Coalition. I will not use any confidential information in any manner that would be detrimental to the Bluegrass Military Affairs Coalition, and I will avoid any actions that might impair the reputation of the Bluegrass Military Affairs Coalition.

I agree with the terms of the above waiver. Please note: If you are under 18, a parent/guardian is only allowed to accept this waiver.

I agree

Make a Difference by Supporting Veterans, Men and Women in the U.S. Armed Forces and their Families