Check One:
Transplant recipient
(type of transplant) (date of transplant, where)
Family member of recipient Friend of recipient Listed for a transplant (where, what type of transplant?) Donor family Other YES! I want to volunteer. If yes, please complete entire form. I wish to volunteer for the following location:
LifeLink of Florida
LifeLink of Georgia (Augusta)
LifeLink of Puerto Rico
LifeLink of Georgia (Savanah)
LifeLink of Georgia (Atlanta)
I would prefer to focus on the following activity(ies) - Click all that apply.
Professional Education(accompany LifeLink staff to hospitalto tell your story to doctors, nurses, andother staff). Varied hours.
Public Education. Varied Hours
Health Fairs
Public speaking(clubs, churches, etc.)
Driver License Offices
Media (letters, interviews, ideas)
Special Projects(administrative/office duties,stuffing/labeling envelopes,wrapping holiday gifts,party planning, etc. - Occur periodicallythroughout year). Usually weekdays.
Times available: Mon-Fri a.m. Mon-Fri afternoons Mon-Fri evenings Weekends
How far are you willing to drive round trip? (Volunteers will be reimbursed for mileage)
less than 20 miles 20-50 miles more than 50 miles
