10th Annual Latina Health Fair

Saturday, May 19, 2012, 10am – 3pm
Sea Mar Plaza 9635 Des Moines Memorial Dr. S. Seattle, WA 98108

VOLUNTEER REGISTRATION FORM
Please return this form to Kristin Whitacre (volunteer@seamarchc.org) by Monday, April 23, 2012
Instructions: Please provide information about yourself in the following table. Electronic submissions encouraged!

Your Name: (Type or print clearly):

Gender: ☐ Male ☐ Female

☐ Other

Spanish language proficiency (please bold or circle one): 5-Certified Interpreter – 4-Fluent – 3-Advanced – 2-Intermediate – 1-Beginner – 0- None Relevant Skills/Experience: (bilingual, computer, attendance at past fairs, etc.) Specialty/Area of Expertise: Is this your 1st time volunteering with the LHF? Yes No If no, what did you do in past years?

Organization Name (if applicable): Your Home Address: City: State: Zip Code: Telephone (Best of cell, work, home): Your email address:

Day-of-Fair Availability:
(Indicate your first and second shift choices. If more than one box is marked with no preference, it will be assumed that you are volunteering for both/all of those shifts.)

Areas that you can assist with: (Check all areas that apply) ☐ ☐ ☐ ☐ ☐ ☐ ☐ Greeters/ Information Registration/Check in Escorts/Runners (Health Screenings Area) Interpreter -- Are you certified? Y N Security/Parking Kids’ Activities I can help wherever I am most needed

Shift ☐ 9am - 12pm (setup + other tasks) ☐ 11am – 2pm ☐ 1pm – 4pm (other tasks + cleanup) ☐ All Day

Rank

Additional Comments about Availability:

Please rank your TOP 3 choices from the above list: 1. 2. 3.
Note: We will try as best as we can to honor your request. However, based on the need we may have to assign you to the area you are most needed in. Thank you for your understanding.

Will you need a certificate of completion/hrs? ☐ Yes ☐ No
T-Shirt Size (limited to Volunteers) ☐ Small ☐ Med ☐ Large ☐ X-Large ☐ Other

Note: Lunch will be provided for all volunteers

For questions, please contact Kristin Whitacre at volunteer@seamarchc.org or 206-764-8040

Thank you for Volunteering at the 2012 Latina Health Fair

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