Nicola Valley Health Care Auxiliary
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Membership Application
Personal Information
*
Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Birth Date
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Access to Transportation
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Yes
No
General Areas of Interest
Hobbies, Sports, Etc.:
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Other Organizations:
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Previous experience with other auxiliaries?
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Yes
No
If yes, where and when?
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Auxiliary Areas of Interest
Roles with the Auxiliary
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Coffee Wagon Program
Gift Case/ Vending Machine/ TV at NV Hospital
Thrift Shop
Other
Are you interested in a position on the Auxiliary Executive?
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Yes
No
If yes, which area is your interest in?
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Treasurer
Secretary
Director
Publicity
Availability
Morning
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Monday AM
Tuesday AM
Wednesday AM
Thursday AM
Friday AM
Afternoon
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Monday PM
Tuesday PM
Wednesday PM
Thursday PM
Friday PM
Weekend
*
Saturday AM
Saturday PM
Sunday AM
Sunday PM
References
Name (1)
*
First
Last
Phone Number
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Name (2)
*
First
Last
Thank you for your interest in volunteering with the Nicola Valley Health Care Auxiliary. We will be in touch shortly regarding your application. Please note that if your application is accepted, a criminal record check and an $8.00 yearly membership fee is required prior to becoming a member.
Phone Number
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Home
About Us
Our Members
Thrift Shop
Community Impact
Get Involved
Contact Us