First Name *

Last Name *

Date of Birth *

Address *

City *

State *

Zip *

E-Mail *

Home Phone *

Cell Phone

Drivers License Number *

During which hours are you available for volunteer assignments? (Hold shift key to select more than 1 option) * Weekday morningsWeekday afternoonsWeekday eveningsWeekend morningsWeekend afternoonsWeekend evenings

Which areas are you interested in volunteering? (Hold shift key to select more than 1 option) * Fishing/Boating TripsSpecial EventsServe on the Board of DirectorsFundraisingServe on a CommitteeOther

Person to notify in case of emergency *

Phone Number of Emergency Contact *

Your Signature here is an electronic signature. This gives LGF permission to do a Background Check *