VITA West Michigan Volunteer Application
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Email *
First Name *
Middle initial
Volunteer Last Name *
Home Address (Street Number and Name, Rural Route, PO Box)
City
State
Zip
Email Address:
Cell Phone
Texting?
Clear selection
Home Telephone Number
Ottawa or Kent County? *
Required
Birth Date (mm/dd/yyyy)
MM
/
DD
/
YYYY
Gender *
Race *
Required
Ethnicity *
Language(s) spoken:
Person to Notify in Case of Emergency
Emergency Contact Phone Number
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