Volunteer Expression of Interest Form

The Lakeside QRU is devoted to helping others and we need caring and compassionate team members to further our mission of service. There are many ways your talents and skills may benefit the Lakeside QRU. Thank you for taking the time to fill out this form and tell us how you would like to contribute to the success of the Lakeside QRU.

Part A. Contact Information
Name
Physical Address
Email Address
Phone Number
Best time to call
Are you interested in serving in an Emergency Medical Response position? Yes?
If Yes, complete Part B
Part B. Medical or Healthcare Skills or Interest

Please indicate your medical certification level:

None, but willing to take training to become an EMR or EMT (QRU may assist with education costs!)
EMR
EMT
Paramedic
Other healthcare position or experience (explain below):

Healthcare licenses or endorsements you hold or have held:

Part C. Other Volunteer Functions and Skills

Please tell us what support functions or skills you would like to contribute (check all that apply):

Serving as a member of the Board of Directors
Fund raising
Computer and Information Technology
Clerical
Facility maintenance/construction
Financial
Website and/or Graphic Design
Public Relations and/or Marketing
Vehicle maintenance/repair
Other – please list:

Part D. Level of Commitment

The Lakeside QRU welcomes all levels of experience and donations of time. Please indicate the time commitment you are considering:

1-5 hours per month
6-10 hours per month
11 or more hours per month

Part E.

What else would you like us to know about you?

You are welcome to call Kim Eisenlohr, QRU Community Outreach Coordinator at (406) 219-1214 for more information. Thank you for your interest in the Lakeside QRU!

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