Lightning in a Bottle 2019 Medical Volunteer Application
Welcome! Spots are limited so we need your info ASAP.
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
What city do you currently live in? (LA, SF, SD, Orange County, etc) *
Your answer
Date of Birth *
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Link to Facebook Profile *
Your answer
Are you planning on volunteering for Lightning in a Bottle Medical? *
Level of Certification (CPR/FA, EMT, RN, MD, LCSW, MFT, etc.) *
Your answer
Previous medical/first aid experience *
Your answer
Previous festival experience *
Your answer
Previous festival medical experience (Have you ever done medical for a festival before? Which?) *
Your answer
Have you volunteered with RGX Medical before? *
Which day and time do you anticipate arriving onsite? *
Which day and time do you anticipate departing from site? *
Are you interested in volunteering pre-event or post-event? (There are a few shifts available pre/post for build/strike) *
Are you planning on camping with medical camp? *
If you are camping with medical, please briefly describe your camping set-up/foot print. (For example, camping in a 4-person-tent with a 10x10 pop-up) *
Your answer
Were you referred by someone? Who? *
Your answer
Emergency Contact Name and Relationship to You (e.g "Mother") *
Your answer
Emergency Contact Phone Number *
Your answer
Anything else we should know? (This section is important. Please fill out anything relevant.) *
Your answer
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