American Red Cross

Information Sheet

Would you be interested in any of the below:

Volunteering your professional skills? (Blood Drives, Natural Disasters, Instructor)

Yes    No

If so, in what area: Blood Services Health & Safety Services Disaster Services Administration Financial Development Youth Services Where Ever Needed

Like to receive our local newsletter, Crosstalk?

Yes    No

Taking a CPR/First Aid Course?

Yes    No

Sponsoring or participating in special events? (Golf Tournament, Yard Sale, Christmas Trees)

Yes    No

Becoming a VIP Blood Donor? (donate at least four times per year)

Yes    No

Typed for the Bone Marrow Registry?

Yes    No

Have you ever received assistance after a fire/disaster, saved someone's life through CPR or First Aid, received a pint of blood or bone marrow transfusions?  Would you be willing to share your story with our chapter?

Yes    No

Please fill out the information below if you would like more information regarding your interests!  Please read our

privacy policy if you have any questions about what we will do with this information.

Thank you and remember Together, we can save a life!

Full Name:

Are you under the age of 18 years of age?  If so, would you be interested in our Chapter's Youth Services Program?

Yes    No

E-mail Address:

           Address:

          Zip Code:

Day-time Phone Number with area code: