Lifesaver Application Lifesaver Application Thank you for your interest in serving as a Lifesaver to the 2012 swimmers! Question Title * 1. Are you a new or returning Lifesaver? New Returning Question Title * 2. Why are you interested in being a Lifesaver? Question Title * 3. How many years have you participated in the Swim A Mile? This will be my second year 3-5 6-10 11 or more Question Title * 4. Do you consider your strengths to lie more in: Swim training Fundraising Both Question Title * 5. How often do you swim? Not very often A few times a month More than once a week Question Title * 6. Where do you swim? (Please include city.) Question Title * 7. Can you commit to calling 20 swimmers to notify them when registration is open? Yes No Question Title * 8. Is there anything else you would like us to know? Question Title * 9. Please provide your contact information below. Name: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 10. I prefer to be contacted by: Phone Email Either Thank you! We will be in touch with you shortly. We expect to open registration in April. If you have any questions, you can reach Christine, our Swim A Mile coordinator, at swim@wcrc.org. Done
