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RSVP Application Form
RSVP Application Form
RSVP Volunteer Membership Application
Your name
*
Prefix
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Middle
Last
Date of birth
*
MM slash DD slash YYYY
Current age
*
Please enter a number greater than or equal to
55
.
You must be at least 55 years of age or older to enroll in this program.
Shirt Size
*
Small
Medium
Large
XL
2XL
3XL
4XL
Home address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home phone
*
Mobile phone
Email
*
Enter Email
Confirm Email
Demographic Data
Please select
all
that apply to you. This data is for statistical information only. Submission of information is voluntary.
Gender
Male
Female
Marital status
Single
Married
Divorced
Widowed
Veteran
Yes
No
Additional demographics
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
If there are any special accommodations needed to assist you in service, please list below:
I am applying to volunteer at:
Previous/Current Occupation
Previous/Current Employer
Referred to RSVP by:
Where do you currently volunteer?
Volunteer Opportunities
I am not currently volunteering and would like to know of volunteer opportunities available.
Free Supplemental Auto Liability Insurance Information
RSVP is required to carry supplemental accident and personal liability coverage for its volunteers.
Driver's License Number
Expiration Date
MM slash DD slash YYYY
Insurance
Copy of Driver's License or State-issued ID
Max. file size: 128 MB.
If possible, please include a copy of your Driver's License or State-issued ID.
Method of transportation
Own car
Ride with a friend
TAPS
Free Accidental Life Insurance Beneficiary Information
All RSVP members receive free
accidental
life insurance. Please designate your beneficiary or to your estate.
Beneficiary Designation
*
Please designate benefits to my beneficiary
Please designate benefits to my estate
Beneficiary Name
*
First
Last
Relationship
Phone Number
*
Beneficiary Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Texoma RSVP Volunteer Interests/Skills
Administrative
Select All
Office -
filing, receptionist, greeting
Telephone -
answering, calling
Computer skills
Tax preparation
Advocacy
Select All
Elder Care -
Medicare, legal assistance
Nursing Home Ombudsman
Homeless -
mental health, housing, education
Crisis hotline
General
Select All
Household skills -
carpentry, building, handy person, general maintenance
Kitchen aid -
baking, cooking, serving meals
Driving -
transporting others, delivering meals
Gardening -
outdoor plants maintenance / conservation
Fundraising -
event planning for RSVP or other nonprofit agencies
Knitting/Crocheting -
special projects for others in need
Schools -
tutoring, reading, mentoring
Special events -
(short term): county fair, fundraising, mass mailing
Thrift store work
Health
Hospice -
caregiver respite, patient visits
Can you be called upon in case of a natural disaster in our area such as flood, tornado, etc.?
Yes
No
Additional interests not listed above
Terms and Conditions
*
I agree to the Terms and Conditions
I hereby request to enroll as a participant in the RSVP Volunteer Program. I understand that my service is voluntary and I agree to serve without compensation. I certify that I am at least 55 years old and that I maintain automobile liability insurance equal to or greater than the minimum required by state law.
Phone
This field is for validation purposes and should be left unchanged.