LifeShare Registry

VOLUNTEER

First Name

Last Name

Address

City

State

Zip

Day Time Phone

Evening Phone

Age

Current Employer

Occupation

Ethnic Origin

African-American		Caucasian		Hispanic
Native-American		Other

Type of Volunteer

Transplant Recipient

Recipient Family Member

Future Recipient

Future Recipient Family Member

Donor Family Member

Other

Transplant Recipient Information

Date

Type of Transplant

Hospital

Type of Transplant you are waiting for

Donor Family Information

Name of Loved One

Your Relationship to Donor

Date of Donation

Volunteer Interests

Speaking Engagements		Media Interviews
Health Fairs		Special Events
Tag Agencies		Office Work

Dates and Times Most Often Available

Monday	Tuesday	Wednesday
Thursday	Friday	Saturday
Sunday

Early Mornings

Mid Mornings

Afternoons

Evenings

I Am Willing To Travel

30 Minutes

1 hour

2 hours

My Story

VOLUNTEER WORK

Volunteer opportunities vary from working at health fairs and other community events, to speaking about donation to civic clubs, church groups and businesses, to telling the media about your donation or transplant experience or providing valuable help in the LifeShare offices.