Volunteer Form

SeniorNet Sarasota Learning Center
Volunteer Registration
The Jewish Federation - 580 McIntosh Road, Sarasota 34232

YOU MAY PRINT THIS FORM - THEN POSTAL MAIL IT

NAME: ____________________________________________________________
            ^{FIRST
MIDDLE
INITIAL
LAST}

Nickname if any, for badge: _____________________________

Address: __________________________________________________________

City: _________________________________ State: FL Zip _____________

Phone Number: ___________________________

FAX Number, if any: ___________________

E-Mail Address: __________________ @_________________

Name and Phone Number of contact person in case of emergency:

______________________________________________________
^{Name
Phone Number}

Your Short Background Biography: _____________________________________

__________________________________________________________________

Are you an IBMer: Yes:_____ No:_____

Months you MIGHT be available to teach (check all that apply):

[ ] January and February

[ ] March and April

[ ] May and June

[ ] July and August

[ ] September and October

[ ] November and December

Thank you for your time and effort........ please mail this completed form to:

Myron Levin
SeniorNet
The Jewish Federation
580 McIntosh Road, Sarasota 34232