Member Information



10668000Florida Association of Directors of Volunteer ServicesNew Member Application00Florida Association of Directors of Volunteer ServicesNew Member ApplicationActive Membership is open to persons employed by a state licensed health care institution who have primary responsibility for volunteer services program.Member InformationFull Name:Date: LastFirstM.I.Title:Address: Street AddressSuite/RoomCityStateZIP CodePhone:( ) Cell:( )Fax:( )Email: Birthday:Health Care Institution InformationInstitution:Not for profitInvestor OwnedCounty Funded Institute NameAddress: Street AddressSuite/RoomCityStateZIP CodeCEOPosition you report to:Number of BedsNumber of Employees:Number of Volunteers:Other InformationHow long have you been engaged in the management of this volunteer program?Number of staff you supervise:Your primary work responsibilities:Positions you supervise?Program InformationCheck all those that apply to our institution and indicate number of volunteers in each program. Auxiliary Non Auxiliary Red Cross Teens Hospice Community ServiceDescribe other programs:Check areas of interest: Program/EducationNewsletter Finance Computer Legislation Historian Audio Visual BoardNew DVS MentorParliamentary BylawsCertificationPhotographerResource Information Nominating CommitteeOtherProfessional Affiliations/Committees/Projects/Offices HeldOrganizationPositionDateDues InformationRemittance of dues must accompany this form. Make check or money order payable to FADVS and return to the Treasurer.Gerry Sanabria, CDVSVolunteer Services ManagerFlorida Hospital East Orlando7727 Lake Underhill RoadOrlando, FL 32822407-303-6797Annual dues in the amount of $50.00 are enclosed.I understand that the Association may deposit the enclosed due remittance pending consideration of this application and, in the event membership is not approved, the Association will promptly refund my remittance. Processing of application takes approximately 5 weeks from date of receipt. Signature: Date: -1524006350Office Use OnlyReceived: Approved: 00Office Use OnlyReceived: Approved: ................
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