Neighborhood Distribution Center
Volunteer Update Form

Update Your Contact Information

In the event of an emergency, we will need to contact our trained volunteers immediately.  If you have been previously trained to work as a volunteer at a Neighborhood Distribution Center, and your home and/or work contact information has changed, we ask that you complete the below form so we can update our records.

All information provided will be kept confidential and used only by Sedgwick County MMRS.

First Name:    Last Name: 

Organization/Company: 

Profession/Credentials (ex. Police Officer, Medical License)

Site Worker Position (ex. Medical Dispensing worker) 
Select Position Assessment Worker Exit Worker Medication Dispensing Worker Medication Preparation Mental Health Worker Reception Worker Registration Worker Runner Security Site Incident Commander Supervisor
 

Address 1: 

Address 2: 

City:    State: 

Zip: 

Phone numbers:
Please include the area code for the phone numbers listed.

Home:
Work:
Cellular:
Pager:

E-Mail: 

Form Validation: 
Enter the letters as shown (lower case) in the box next to the form field:  

---

©, Copyright, 2004 Sedgwick County Health Department
last update: 11/15/06
Please report problems to the webmaster
ALL RIGHTS RESERVED

Fact Sheets Personal Preparedness Para la versión en Español de la tarjeta de alerta personal del MMRS, por favor oprima aquí Muon biet ve phan tieng Viet, xin vui long nhan con chuot o day FOR CITIZENS Emergency Preparedness & Response Frequently Asked Questions Bioterrorism & Public Health Emergency Facts MMRS, What is it? Neighborhood Distribution Centers Neighborhood Distribution Center Volunteer Update Form FOR CLINICIANS Bioterrorism Information Handbook for Clinicians - January 2003   Revisions Archive Biological Agents - Vaccine, Therapy, and Prophylaxis Table Common Biowarfare Agent Characteristics Infection Control and Epidemiology for Suspected Bioterrorism Agents Smallpox Hospital Guide Other Information Emergency Planning Guide Post Exposure Mass Pharmaceutical Distribution Medication Preparation Video Preparedness Training Press Releases Resource Links Anthrax Facts CDC Public Health Emergency and Response CDC en Español - Terrorismo Biológico Kansas Health Alert Network Ready.gov Smallpox "Terrorism—Preparing for the Unexpected" - American Red Cross United States MMRS US Department of Homeland Security     Adobe Acrobat Reader Required   Sedgwick County  MMRS 1530 S. Oliver, Suite 270 Wichita, KS 67218 (316) 660-7360 For more information, call (316) 660-5551