LifeGift Volunteer Registration Form

Thank you for your interest in volunteering with LifeGift. We are excited to learn more about you and your interest in advocating for organ, eye, and tissue donation. Please take a moment to thoroughly fill out this volunteer registration form. Once you have submitted your registration you will receive a list of social and recruitment dates that you can choose from to attend to learn more about our organization, our volunteers, and opportunities.


* required field
CONTACT
 

ADDITIONAL INFORMATION

Emergency Contact

* Emergency Contact
* Emergency Phone
* Emergency Contact Relationship
* Please select any languages you speak
English
Spanish or Spanish Creole
Vietnamese
Chinese
Arabic
French (including Patois
Cajun)
Hindi
Urdu
Tagalog
Persian
Korean
German
Russian
Japanese
Portuguese or Portuguese Creole
Gujarati
Japanese
Serbo- Croatian
Italian
French Creole
Thai
Hebrew
Greek
Polish
Mon-Khmer/Cambodian
Hungarian

Personal Information

Date of Birth
Gender
Ethnicity
Other
Education
T-Shirt

Interests

What is your connection to organ, eye, and tissue donation? (Select Only One)
Concerned Citizen
Medical Professionals
Family of Donor
Recipient
Waiting
Recipient Family
Living Donor
Student
Which outreach activities would you desire to participate in? (Select all that apply)
Speaking Engagements
Registry and Awareness Tables
Special Community Projects
Media
Which target communities would you desire to outreach in? (Select all that apply)
Academic/Schools
Hospital/Health
Multicultural
Community/Civic
Are you interested in becoming a lead volunteer?
 Yes  No
At which hospital do you have a connection to donation?
Please share additional information about yourself or your donation story that you would like us to know.

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Thank you for your interest!


 
 

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