Application For Aarp Connectcut State President Page 2
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2AVAILABILITY:
When are you available to volunteer?
Weekdays: Day
Evening
Weekends: Day
Evening
Please describe the time commitment you can make to the AARP State President position:
________________________________________________________________________________
AARP MEMBERSHIP STATUS*:
AARP Member?
NRTA Member?
Membership No.: ______________________
AARP Chapter Member?
Chapter Name/No. _____________________________
*Applicants need not be AARP members but must be eligible for membership. Acceptance of this
position indicates agreement to become a member of AARP.
________________________________________________________________________________
EMERGENCY CONTACT:
Name: ______________________________________________________________________
Address: _____________________________________________________________________
_____________________________________Relationship: ____________________________
Day: (
) ______________________ Evening: (
)____________________________
________________________________________________________________________________
ACCOMMODATIONS:
What type of special needs or accommodation, if any, would you need to perform your volunteer
function?
_____________________________________________________________________________
_____________________________________________________________________________
________________________________________________________________________________
PERSONAL INFORMATION:
AARP attempts to achieve a balance of age, gender, and race in its programs. You are not
required to provide this information. It is being collected for program evaluation purposes.
Gender:
Male
Female
Race:
African American
Native American
Asian American
Hispanic
Caucasian
Other ____________
________________________________________________________________________________
Please complete, sign and date this form, attach the three required documents and return your
application package by mail or email.
Mail: Elaine Werner, AARP CT, 21 Oak St., Suite 104, Hartford, CT 06106
Email:
YOUR SIGNATURE: _________________________________
Date: ___________________
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