To print this form, highlight the text below and then select File/Print from the menu bar.  Choose "selection" for what to print. RETIRED SENIOR VOLUNTEER PROGRAM  3727 Marconi Avenue Sacramento, CA 95821 (916) 875-3631 REGISTRATION FORM NAME ______________________________________________________ PHONE ___________________     First   Middle   Last         ADDRESS ________________________________________________________________________________       Street/Number   City     Zip Code   EMAIL ADDRESS  __________________________________________________________________________   Birth date ___/___/___    Male ____  Female ____         Married _____  Single _____  Widow/Widower _____   How did you hear about RSVP? _______________________________________________________________   Previous or current occupation: ________________________________________________________________   Do you have special physical needs that require accommodation to perform your volunteer function? If so,   please explain: _____________________________________________________________________________   List of organizations you PRESENTLY volunteer for and your duties:   1. Agency _________________________________ Duties: __________________________________     _________________________________________________________________________________   2. Agency _________________________________ Duties: __________________________________     _________________________________________________________________________________   3. Agency _________________________________ Duties: __________________________________     _________________________________________________________________________________   For purposes of RSVP statistical records, please indicate your ethnicity; however, this is not mandatory.   American Indian/Alaskan Native _____, Asian or Pacific Islander ____, Black (Not Hispanic origin).   Hispanic _____ , White (Not Hispanic origin) _____, Multi-Racial_____ , Other_____ .   I understand volunteering with RSVP does NOT make me an employee of RSVP or of its sponsor, the   Sacramento County Department of Human Assistance.   SIGNATURE: ___________________________________ DATE: _________________________