E-Gov Services Township of Nether Providence

Pandemic POD Volunteer Registration

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Purpose. Complete this form to register as a Pandemic Point of Dispensing (P.O.D.) Volunteer. Volunteers ‘go to the head of the line’ to receive medicines and/or vaccines for themselves and their families. Volunteers truly serve their neighbors and community. Set up for the POD drill will be on June 18 with the drill (including training) taking place on June 19 from approximately 8 until 4. Even if you are unable to participate in June, please consider joining this group. Volunteer rosters are to be kept up to date on an ongoing basis by POD leadership.

* Information is required.

Contact Information

* First Name:
* Last Name:
Email:
Daytime Phone:	() –
Address:
City:
State:
ZIP:

* I wish to register as a Wallingford- Swarthmore School District POD volunteer.

Yes

* I will participate in the June 18th and 19th, 2008 POD exercise at Strath Haven High School. Please send me details on the exercise.

Yes

Do you have medical skills, training, or licenses?

If yes, please specify:

Do you have other special skills which you wish to identify?

If yes, please specify:

Other comments/questions:

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

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