Please return completed application to: AARP, 1415 L Street, Suite 960, Sacramento, CA 95814

□ Influencing Lawmakers: Be part of a team visiting and calling your legislator on issues important to seniors (Health Care, Utilities, Social Security, Medicare and more). Organize advocacy events. Write letters to the editor.

□ Driver Safety Program: Learn about opportunities in the DSP whether you are interested in being an Instructor, District Coordinator, etc.

□ Public Speaking: Become a speaker for a number of AARP programs and priorities. □ Special Events: Staff the AARP booth at health fairs or events where AARP has a presence. □ Communications: Help get the word out to newspapers and other organizations about AARP.

Be trained as a spokesperson on specific topics. □ Facebook Ambassador: Help disseminate advocacy information and get people involved in

your community. □ Other: (please specify)________________________________________________________

Volunteer Application

Mr./Mrs./Ms./Miss/Other: (Circle One) Name: ___________________________________________

Nickname: ____________________________

Address: ______________________________________________________Apt. ______________

City: _________________________________State: ________Zip Code: _____________________

Day Telephone: ___________________Evening Telephone: _______________________________

Fax Number: _______________________________Email: ________________________________

Where did you hear about this volunteer opportunity? _____________________________________ Past Experiences: Share with us past experiences that you would like to use in your volunteer work. __________________________________________________________________________________ __________________________________________________________________________________ Interests/Program Areas: (It would be helpful for us to know other areas that may interest you. Please check all that apply.)

Personal Information: AARP attempts to achieve a balance of age, gender, and ethnicity in its programs. You are not required to provide this information. It is being collected for program evaluation purposes only. Birth Date: _____________________ Gender: Male Female

Race/Ethnicity: African American Native American Asian Hispanic/LatinoCaucasian

Other ________________________________________________________________

I hereby attest that the information I have provided in this application is true to the best of my knowledge.

Signature: ___________________________________________Date: _____________________ FOR OFFICE USE ONLY Approval: ______________________________________Date: ____________________________ Concurrence* ___________________________________________________________________ Title: _________________________________________________________________________ _ Start Date: _____________________________End Date: _______________________________

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