Date
VOLUNTEER REGISTRATION

RSVP of South Bay,
1339 Post Avenue Torrance, CA 90501,
(310) 320-3322
Number____________
First Name Last Name MaleFemale
Street City Zip
e-mail:
Ethnic Group (Optional)
White African American Asian/Pacific Islander Hispanic Other


Birth Date Phone
Profession
Retired from
Physical Limitations? Yes No
If Yes, What?
Do you drive? Yes No
For Internet Security reasons, please do not complete RED areas marked with a *. These areas will be completed during your interview at the RSVP office.
*Drivers License # *Expires *Insured with
For RSVP Insurance Records please complete Beneficiary Information.
*Beneficiary Name *Relationship
*Address *City *State *Zip
*In an Emergency Contact *Phone
Signing this registration form certifies that I will be utilizing either the RSVP Web Site or telephone answer machine to record my monthly hours of volunteering with RSVP.

I understand that if I use my personal automobile in my volunteer service, I will keep my automobile liability insurance current and up to date as required by the State of California.

*SIGNED BY
RSVP Volunteer/Date RSVP Director/Date
*Assigned to Station.