Yes, I am interested in becoming an MRC volunteer. Here is my contact information:
First Name
Last Name
Street Address
City, State, Zip
Phone Number
Fax Number (Optional)
Email address
Do you have a medical background (Dr., Nurse, Paramedic/EMT, Pharmacist, Veterinarian, etc.)? YesNo
If yes, what is your area? Choose Nurse (RN/LPN) Physician Nurse Practitioner Pharmacist EMT/Paramedic Veterinarian Mental Health Counselor Physician Assistant Health Educator Medical Records Expert Respiratory Therapist Physical Therapist
Other (Specify)
PLEASE NOTE: Volunteers (particularly those with medical skills) may receive a more detailed registration form to further define skills, experience, and credentials via email or regular mail.
For questions or further information, please contact:
Travis B. Donnelly, Volunteer Coordinator District Office of All Hazards Preparedness 231 West Tift Ave. Albany, GA 31701-2383 (229) 430-1978 (229) 430-1968 Fax
tbdonnelly@dhr.state.ga.us