Volunteer Registration

If you are interested in participating for Citizen Corps, please provide your contact information below, then click "Submit." We will send you e-mail updates and more program details as soon as they become available. Your  local Citizen Corps Council will be able to contact you to let you know about local events and activities.

Pleas Fill Out Form Below:

Tell us how to get in touch with you:

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FAX
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Best Time of  Day to Reach You

Enter your comments or questions in the space provided below:

Please contact me as soon as possible regarding this matter.

 

By submitting this form, the sender consents to release of his or her name, address and contact information to the entity in which the submitter has indicated an interest. If you do not agree, please click on "Reset" below.

Privacy Act Statement
In compliance with the Privacy Act of 1974, the following information is provided:
The collection of this information is authorized by 5 U.S.C. 301 and Section 2, Executive Order 13254, January 29, 2002. The primary purpose of the form is to provide a means that allows individuals to indicate their interest in volunteer services areas or organizations. Users may also elect to be provided with additional information about other service opportunities. Providing this information is voluntary. All information submitted by a user is available to Citizen Corps (including individual Councils), USA Freedom Corps, those entities in which user expresses an interest, and other entities as specified in the Notice published at 67 FR 30685-01 (May 7, 2002).

GCCHD
Copyright © 2003 Greene County Citizens Corps Council, Xenia, OH 45385

Contact: Mark McDonnell
Title: Health Commissioner
Phone: (937) 374-5630
Email: mmcdonnell@gcchd.org
URL: http://www.gcchd.org. All rights reserved.
Revised: March 18, 2005 .