Sedgwick County, Kansas MRC 1900 E. 9th Street | Wichita, KS 67214 Volunteer Form

Whether you have medical skills, mental health skills or simply want to contribute to public health and safety, we are looking for a variety of willing volunteers.

All information provided will be kept confidential and used only by Sedgwick County Medical Reserve Corp.

First Name:    Last Name: 

Volunteer Service Type
Select Position Licensed Medical Professional Non-licensed with Medical Background Mental Health Professionals Support Specialties Basic Support
Some examples are listed below (Note: This is not an exhaustive list.)

Medical	Mental health	Other Support
Nurses  Doctors Pharmacists Veterinarians Dentists Physician Assistants EMTs LPNs Physical Therapists	Counselors  Therapists Psychiatrists Psychologists Social Workers Drug & Alcohol counselors Clergy	Computer Specialists  Translators / Interpreters Health educators Epidemiology professionals Public information specialists Non-medical volunteers for basic support

Profession/Credentials

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 code displayed in the box next to the form field in lower case:    

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last update: 11/15/06
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