Enrollment Form
Original Date of Enrollmen
t
Name
Experience/Skills
Volunteer Experiences/Interests
FGP and RSVP voluneers are covered by supplemental insurance .Please provide beneficiary information.
All Volunteers: Provide Emergency Contact Information
FGP and RSVP volunteers claiming
mileage reimbursement
:
*If claiming mileage reimbursement, please mail a
copy of your proof of insurance. We cannot provide
reimbursement without it.
I understand that if I use my personal automobile to and from my volunteer workstation,
I will arrange to keep in effect automobile insurance equal to or greater that the
minimum required by the state.
1302 Lankford Drive, Valdosta GA 31605
229-671-1414
Senior Volunteer Connection of South Central Georgia
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