DR Volunteer Database
Registration
Personal Record
Personal Record
Preferred First Name or Nickname
- What People call you.
Legal First Name
Legal Middle Name
Legal Last Name
Legal Extension
- Jr, Sr, III, etc
Your Mailing Address
How Long Have You Lived Here?
- How Long Have you lived at this address?
City
Zip Code
County
State
Date of Birth ( Enter As: MM/DD/YYYY )
- Your DOB will also become your password when you sign up online for training.
Height
Sex
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Male
Female
Color Hair
Brown
Black
Blonde
Grey
Brn/Grey
Gray/Brn
Blk/Grey
Grey/Blk
Red
Auburn
White
Color Eyes
Brown
Blue
Hazel
Green
Blue/Grn
Black
Email
Home Phone
Cell Phone
Work Phone
Ham Radio Call Sign
- If you are an Amateur Radio Operator, your Call Sign
Ham Class
- Your Amateur Radio Classification.
Association
Alabama-Crenshaw
Autauga
Baldwin
Barbour
Bessemer
Bethel
Bethlehem
Bibb
Bigbee
Birmingham
Blount
Bullock-Centennial
Butler
Cahaba
Calhoun
Carey
Central
Cherokee
Chilton
Choctaw
Clarke
Clay
Cleburne
Coffee
Colbert-Lauderdale
Columbia
Conecuh
Coosa River
Covington
Dale
Dekalb
East Cullman
East Liberty
Elmore
Escambia
Etowah
Fayette
Franklin
Friendship
Geneva
Hale
Judson
Lamar
Limestone
Lookout Mountain
Madison
Marion
Marshall
Mobile
Montgomery
Morgan
Mud Creek
Muscle Shoals
North Jefferson
Pickens
Pine Barren
Pleasant Grove
Randolph
Russell
Salem-Troy
Sand Mountain
Sardis
Selma
Shelby
Sipsey
St.Clair
Sulphur Springs
Tallapoosa
Tennessee River
Tuscaloosa
Tuskegee-Lee
Walker
Washington
West Cullman
Winston
- The local Baptist Association your Church is affiliated with.
Church
- The Name of your Church
Emergency Contact/Beneficiary
- Someone who will not be traveling with you.
Emergency Phone
- The phone number of your Emergency Contact.
Do you have a current Passport?
Yes
No
What Special Skills Do You Have?
- Dr, Nurse, CDL, Heavy Eqpt Operator, etc.
How Much Notice Do You Need?
Immediately (6-24 hours)
At Least One Week
One Week or More
Ask (Call Me)
- How quickly you can deploy after being called.
Do You Have Medical Insurance?
Yes
No
- You must have Medical Insurance to serve in Disaster Relief
InsuranceCarrier