Group Volunteer Application Form - Ray Graham Association

Company or Volunteer Group Name

Leader's Last Name

Leader's First Name

Address

City

State

Zip Code

Telephone Number

Email Address

Secondary Contact Name and Relationship

Secondary Contact Phone Number

Phone Number Type

When are you available to volunteer?

Location Preference

Desired Date

Types of volunteer work you think you’d be most are interested in

Volunteer Group Leader Digital Signature: I hereby Release and Waive liability against RGA, a non-profit organization, its directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I myself or my group may suffer in connection with any volunteer work for RGA. Further, I agree that RGA, is not liable for any damage to my property or my group’s property resulting from volunteer work for RGA. I agree that this release is as broad and inclusive as permitted by the laws of the State of Illinois.

Date