Username: * Please enter your first name dot last name eg: john.smith
E-mail address: * A password and instructions will be sent to this e-mail address, so make sure it is accurate.
Subscribe to Hatian Earthquake Volunteers. (approval needed)
Rank or Title: Please enter your military or civilian rank or title
Organization: *
Work phone: * Please include a valid country or area code, e.g. +1 604 555 5555
Work Fax:
Mobile Phone:
Birth Year: Please enter year of birth as 4 digits, e.g. 1970
Medical: Nurse
Medical: Emergency Medical cert
Medical: Mental Health Counseling
Medical: Veterinarian
Medical: Veterinarian technican
Medical: Nurses aide
Medical: Home healthcare aide
Medical: Care worker
Other medical profession: If medical professions above do not fit you, use this space
Professional: Police
Professional: Firefighter volunteer
Professional: Firefighter paid
Professional: EMT
Professional: Hazmat Specialist
Professional: Forest Services
Professional: Certified Emergency Manager
Professional: CERT Trainer
Professional: CERT Team Member
Professional: MERT Team Member
Communication support: CB or ham radio operator
Communication support: Hotline Operator
Communication support: Public Relations
Communication support: Own cell phone If you own a cell phone, please enter the number in "my contact details" area
Communication support: Own satellite phone
Satellite phone number :
Communication support: Web Page design
Communication support: Public speaker
Communication support: Network Administrator
Communication support: Systems Engineer
Office support: Clerical
Office support: Phone Receptionist
Office support: Data Entry
data entry software:
Services: Food
Services: Elderly/disabled asst.
Services: Child care
Services: Spiritual Counc.
Services: Social work
Services: Search & Rescue
Services: Auto repair/towing
Services: Traffic control
Services: Crime watch
Services: Animal rescue
Services: Animal care
Services: Other
service skill:
Transportation: Car
Transportation: Station wagon or mini van
Transportation: Maxi-van
Maxi-van capacity:
Transportation: ATV
Transportation: Own off-road vehicle, 4 wheel drive
Transportation: Own truck
Transportation: Own boat
Boat capacity:
Boat type:
Transportation: Commercial driver
Class and License:
Transportation: Camper/RV
camper/RV capacity:
camper/RV type:
Structural: Damage assessment
Structural: Metal construction
Structural: Wood construction
Structural: Block construction
Structural: Plumbing
plumbing cert. number:
Structural: Roofing
roofing cert. number::
Equipment: Chainsaw
Equipment: Generator
Equipment: Other
other equipment::
Labor: Loading/shipping
Labor: Sorting/packing
Labor: Operate equipment
types of equipment operated:
Labor: Experience supervising
Labor: Electrician
Labor: Engineer
Labor: Plumber
Labor: Construction Worker
Labor: Corporate Manager
Labor: Construction Supervisor
Labor: Foreman
Labor: Administrative Supervision
Labor: Warehouse Manager
