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 Executive Director Jordan Owen at 406-285-8400 for more information. Thank you for your interest in the Lakeside QRU!

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