Date:  

    Last Name:          First Name:          MI: 

    School Address (Temp): 

    City:        State:         Zip:        Phone: 

   Parent's Address: 

    City:        State:         Zip:        Phone: 

    Date of Birth:          Gender:  Male    Female

    OPTIONAL STATISTICS

        Race:        Marital status:        US Citizen?  Yes  No

        Disabled?:  Yes  No

    E-Mail Address: 

PLEASE READ AND SIGN

I understand my responsibilities as a member of Campus Red Cross are to attend general club meetings.  Meetings will be announced in the Daily Nebraskan and posted on campus.

I understand it is my responsibility to record all volunteer hours on the forms provided and to report them to the club secretary within two weeks of the event/time worked.

I understand that attendance will be taken at all general meetings.  It is my responsibility to record my own attendance on the attendance sheet.

* Typing in your name in the below textbox is equivalent to signing your name.  By typing your name, you agree to all the above and wish to join Campus Red Cross.

        Name: