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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General Information Background Frequently Asked Questions Heart of America Medical Reserve Corps Review Newsletters Local Events Volunteer - Non-Emergency Roles Public Health Emergencies Fact Sheet Volunteers Who can volunteer Volunteer Form Training Fact Sheet 2007 Incident Command System Online Training Resource Links The Medical Reserve Corp Citizen Corps USA Freedom Corps Prevention and Preparedness: Medical Reserve Corps Serving America Sedgwick County Health Department Adobe Acrobat Reader Required   Sedgwick County  Medical Reserve Corps 1900 E. 9th Street Wichita, KS 67214 (316) 660-5551