Name: 

Birthday: 

Male       Female  

Email: 

Home Address: 

City:     Zip: 

Home Phone: 

Bus. Address: 

City:     Zip: 

Bus. Phone: 

May we contact you at work?   Yes     No

Permanent     Part-Time Resident

Other address if part-time resident:

Address: 

City:      

Phone: 

Marital Status:  Single     Married

Spouse's Name (if married): 

Divorced   Widow     Widower

In case of emergency, notify (relative or close friend living near your home):

Name: 

Address: 

City: 

State: 

     Zip: 

Phone: 

Relationship: 

Describe your state of health in the box below:

Describe any physical restrictions in the space below:

Are you taking any medications we should be aware of in case of an emergency?  Yes (List)   No

EDUCATION

Highest school/college year completed:

Field of Study: 

Degree: 

Professional Certification: 

EMPLOYMENT

Current Employer: 

Job Title: 

Brief Description

If retired, what type of work did you do? Incl. Job Title and brief description

VOLUNTEER SERVICE

Other current volunteer service/Agency:

Briefly describe duties:

Previous volunteer service/agency:

Number of years of volunteer service:

RELATED EXPERIENCE

Do you have any special skills or hobbies (please list):

Are you proficient in a language other than English?
Yes   No   If Yes, please specify:

Would you be willing to help with special events/projects as needed?  Yes     No

Why do you want to volunteer for the Lee County Visitor and Convention Bureau?

How did you learn about volunteer opportunities with Lee County Visitor and Convention Bureau?