OLAFR Inc. Volunteer Questionnaire

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Answers to the following questions are for use by OLAFR Inc. only. The intent is to allow our database maximal information so that in the event of an emergency we can quickly and efficiently deploy persons most suitable to assist in that particular situation.

Name (first and middle initial): *

Name (surname): *

Address (line 1): *

Address (line 2):

Address (Town or City): *

Address (Zip): *

Telephone (landline - if none enter "none"): *

Telephone (cell - if none enter "none"): *

Telephone (other):

E-mail (if none enter "none"): *

Age (not required, but is helpful):

Are you an OKMRC (Oklahoma Medical Reserve Corps.) member? *

Yes

Do you have an OKMRC Badge? *

Yes

Not OKMRC Member

If badged OKMRC member, badge number (from reverse of OKMRC badge, at bottom):

Are you a veterinarian? *

Yes - Large Animal

Yes - Small Animal

Yes - Non-Practising

Required

Other status/involvement offered to OLAFR (check all that apply): *

Veterinary Technician

Animal Handler

Transport driver

Supply distribution

Fundraiser

Evacuation/Foster Facility

Office/Telephone

Donor

Required

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