Volunteer Interest Form Hi! I am interested in learning more about becoming a volunteer . . . Question Title * 1. Contact Information Name: Address: City/Town: State/Province: -- 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 Code: Question Title * 2. Preferred Method of Contact (complete one or more): Phone: Email: Other: Question Title * 3. Programs I am interested in (check all that apply): Community Connections Team in Eau Claire Community Connections Team in Marshfield Community Connections Team in Stevens Point Please expect a volunteer coordinator to follow up with you within a week. Thank you Marshfield Clinic Health System - Center for Community Health Advancement 715-221-8400 communityhealth@marshfieldclinic.org Done
