Volunteer Application Form

Please complete this application form if you are interested in becoming a Door County Medical Center Auxiliary volunteer. Once you complete the form, click the Continue button at the bottom.

Name, Address

Fields with * are required

First name:

Last name:

Street address:

Apt. #:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

(year optional)

Gender:

Availability

Please indicate the days and times you are usually available to volunteer.

Membership Preference

- Active members of the Auxiliary participate in volunteering in the hospital and fund raising activities.

Dues: $25.00 (annual fee)

- Supporting members of the Auxiliary will participate in volunteering outside the hospital and fund raising activities.

Dues: $25.00 (annual fee)

- Life members of the Auxiliary participate in volunteering and fund raising activities.

Individual Dues: $150.00 (one-time fee)

Couples Dues: $225.00 (one-time fee)

Type:

Skills and Interests

Please indicate any areas of skills or interests. Use the check boxes below to select as many of the areas that apply.

Assignment Preference

In what areas are you interested in volunteering?

I Agree

I understand and agree that submitting this application form does not automatically register me as a Door County Medical Center Auxiliary volunteer, and that there will be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. All applicants will be asked to complete and submit a Hospital Auxiliary Background Information Disclosure form. Additionally, Active and Active-Life applicants will be asked to participate in a Medical Clearance process (at no cost to the applicant) prior to volunteering in the Hospital. Member dues will be collected at the time of orientation.

I Agree