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About Us Volunteer

Volunteer Application


Volunteer Application

  1. The membership of the Ephraim McDowell Regional Medical Center Auxiliary is open to anyone who is interested in the welfare of the hospital. We welcome all new members. Dues are $4.00 for active members, $5.00 for associate members and $100.00 for life membership.

    Quarterly general meetings are held throughout the year. Members also participate in fund-raising efforts.

  2. Name*
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    Last , First and Middle Initial
  3. Address*
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  4. City*
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  5. Zip*
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  6. Home Phone*
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  7. Work/ Cell Phone*
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  8. Email Address*
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  9. Education
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  10. Degree Earned
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  11. Work Status*
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  12. Last Employment
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  13. Past Work Experience
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  14. Three Types of Volunteer Work You Would Like to Do
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  15. List the days and hours during the week and weekends that you will be available to volunteer
  16. Available Hours
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    Enter day and time
  17. How Often Would You Like to Volunteer
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  18. How Were You Referred to our Volunteer Program
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  19. In case of an Emergency, please notify
  20. Name
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  21. Relationship
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  22. Home Phone
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  23. Work Phone
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  24. Physician
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  25. Physician Phone
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  26.   
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