registration form

Please complete the Registration Form for Rayne LA below. You will receive confirmation when your reservation is received and approved. After approval and dates are confirmed, please complete Volunteer Packet and return pages 10-14 no later than two weeks prior to arrival date:

LA Conference of The UMC Disaster Response, Inc.

P. O. Box 2388

Baton Rouge, LA 70821

Office: 225-346-5193

Fax: 225-346-6974

Health Insurance that covers accidents or accident insurance is required to participate. The information regarding how to obtain GBGM Accident Insurance is included in the Volunteer Packet. A volunteer that waives the accident insurance is responsible for all expenses.

A check for the Housing fee of $15.00 per day per person should be made payable and mailed to the LA Conference of The UMC Disaster Response, Inc. no later than 14 days prior to arrival date.

If you are interested in Metro New Orleans area, register at the Epworth Project website.

Registration Form - Rayne LA

Complete the following volunteer information to register as an individual or as a team of people. Someone will contact you shortly to confirm your registration.

If you have any questions, call Melanie or Candy at 225-346-5193 or Contact Us.

INDIVIDUAL OR GROUP NAME:

UMC CONFERENCE:

CONTACT NAME:

STREET OR MAILING ADDRESS:

CITY: STATE: ZIP CODE: COUNTRY:

DAYTIME PHONE: BEST NUMBER TO CALL:

EVENING PHONE:

CELL PHONE:

EMAIL:

ARRIVAL DATE: DEPARTURE DATE:

TOTAL NUMBER OF VOLUNTEERS INCLUDING YOURSELF:

Do you have accident insurance? Yes No

If you do not have Accident Insurance Coverage - please click on Insurance Application Form with the General Board of Global Ministries.

What are your team's housing needs?

Require housing

Have camping trailers

Will secure own housing If your team will secure own housing:

Please indicate any special skills of your team including yourself (Check all that apply):

Construction (or closely related industry)

Roof, Electrician, Plumbing, HVAC:

COMMENTS: