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Ready to volunteer?

Please complete the following survey. Your information will be sent directly to our LDR volunteer coordinators working in the hurricane-affected areas, and they will contact you to set up your trip.  Please understand that filling out the form does not mean that your group is booked to volunteer.  Thank you for your interest!
First name   
Last name
 
City, State ZIP Code
Primary Phone number
Secondary Phone number
E-mail address
Confirm
e-mail

Are you volunteering as an individual, a family, or on behalf of a group/congregation?


Estimated MAXIMUM size of group (including yourself):

        Adults (18+):
        Youth (16-17):

Available time:

           Arrival Date: "MM/DD/YYYY"
        Departure Date:

Preferred state:

Experience Level (you or the average member of your group):

Work Skills:
   

Do you (or members of your group) have any special certifications?
(e.g. EMT, MD, CDL, licensed electrician, clinical social worker)

Other comments: