Step 1 of 6 16% Contact InformationFirst NameLast NamePreferred First NameDate of BirthAddress Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code NeighborhoodCountyGeographic Area--- Select One ---Centreville/LightfootEast York & James CityJohn Tyler/JamestownUpper CountyWilliamsburg CityPrimary EmailHome Phone NumberCell Phone NumberWork Phone NumberEmergency Contact NameEmergency Contact RelationshipEmergency Contact Phone Driver's License & Vehicle InformationDriver's License NumberState Issued by:Expiration Date Car Insurance CompanyInsurance Expiration Date Insurance RenewsSemi-AnnuallyAnnuallyNumber of passengers your car can seatVehicle TypeCompact CarMid- to Full-Size CarLow SUV/VanHigh SUV/VanSmall Pickup TruckLarge Pickup Truck AvailabilitySunday Morning Afternoon Evening Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening OtherAre you willing to be called for short notice assignments?YesNo Areas of InterestCheck all areas you are interested in volunteering Local Transportation Transportation to the Peninsula Transportation to Richmond Minor Home Repairs Yard Work Care Giver Support Paperwork for Care Receivers Telephone Calls In-Home Visits Shopping for Care Receivers Visiting Canines WFIA Office Support Household Chores Pet InformationCheck all that apply Allergic to cats Allergic to dogs OK with pets in home Willing to transport pets Misc. InformationEthnicityAfrican AmericanAsianCaucasianChineseFilipinoHawaiianHispanicIndianJapaneseKoreanNative AmericanPacific IslanderOtherAre you a veteran?YesNoAre you a smoker?YesNoAre you allergic to cigarette smoke?YesNoDo you give permission to WFIA to use your name/image in print or on the Web?YesNoCongregation you are affiliated withInterests/HobbiesList other languages you speakOccupationList any physical limitation we should consider in making your assignmentsList any convictions or viloations of any laws, traffic or otherwiseName First Last CAPTCHA Δ
