TCI Red Cross Membership Registration Form

$20 membership fee valid from January to December

Mr./Mrs/Miss:

Family Name

First Name

Residential address:

Phone  Numbers:     

Home:

Work:

Cell:

EXT #

Where do you work ?

May we contact you at work   

YES

NO

e-mail 1:

e-mail 2:

Do you have Red Cross or other relevant experience /qualifications?

Do you wish to receive Red Cross Training in:

CPR/AED

First Aid

Community Based Disaster Preparedness

Disaster Preparedness

Please indicate your area of volunteering interest:

First Aid

Fund Raising

Disaster Management

PR/Information

Thrift Shop /Office Services

HIV/AIDS

Comfort Support Group

Other

Typing your name in box below will be considered your signature

Signed:

Date:

address line 2

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