American Red Cross - R e g i s t r a t i o n

American Red Cross Registration

We thank you for your time and interest in the American Red Cross. The following form should take no more than a few moments of your time to complete and will help us provide you with information to help you and your family prepare for emergencies and become more involved with the local Red Cross chapter in your community.

Profile Information - * required field
Tell us about yourself by completing the sections below.

Email Address:	*
Password:	* Passwords must be at least 6 characters and contain both letters and numbers
Salutation:
First Name:
Middle Name:
Last Name:
Address:

City:
State:
or Province:
Country:

ZIP/Country Code:	* xxxxx
Home Phone:	xxx-xxx-xxxx
Cell Phone:	xxx-xxx-xxxx
Business Phone:	xxx-xxx-xxxx
Fax:	xxx-xxx-xxxx

Gender:	Male Female
Professional Title:
Company:
Household Annual Income:

Current Red Cross Relationships -
Have you ever donated or given some time to your local Red Cross or other Red Cross affiliate?

Are you a Volunteer?	Yes No
Last Date Volunteered:
Are you a Disaster Services Human Resources (DSHR) Volunteer?	Yes No
Have you donated money?	Yes No

Have you donated blood?	Yes No
Have you taken a Red Cross course?	Yes No

Current Red Cross Interests -
Let us know what is important to you. What subjects would you be willing to receive more information about?

	Disaster Response
	Disaster Preparedness
	Disaster Updates
	Regional Disaster Information
	First Aid/CPR
	Safety Tips

	Teen Programs
	Elderly Programs
	Parent/Child Programs
	Swimming Lessons
	Babysitter Training
	Workplace Training

Current Newsletters Available for Subscription -
The following newsletters are available for subscription. Each is packed full of useful information to share with your family and community. At anytime you can unsubscribe from these newsletter from links within the text.

	1 Minute Update - Monthly newsletter of Red Cross news, safety tips and disaster updates.
	SafetyNET - Quarterly newsletter offering the latest in workplace safety.

Disaster Updates - Regular news updates on major disasters and Red Cross relief efforts.