Where would you like to help out? Check all that apply.

Anchorage Center
Dimond Mall Center
Mat-Su Center
Kenai Peninsula Center
Fairbanks Center
LIFEmobile

Affiliation: Are you affiliated with a group that sponsors blood drives?

Yes No

Name of Group:

What is your availability? Check all that apply.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Morning
Afternoon
Evening

Are you available to substitute on short notice / on call?

Yes No

Are you 18 years of age or older?
(Under 18 requires Parental Consent Form)

Yes No

Why are you interested in volunteering your services to the Blood Bank of Alaska?

School Credit
Community Service
Job Training

Other:

Please describe any previous volunteer experience:

Please list work experience at your current or previous job and briefly describe duties:

Do you have phlebotomy experience?

Yes No

Do you have proof or documentation of recent Bloodborne Pathogen / OSHA training?

Yes No

How soon are you available to volunteer your services?

Providing your contact information on our web site for the purpose of volunteering your services to the Blood Bank of Alaska implies your consent that we can use the contact information you provide in order to get in touch with you via e-mail or telephone.