Last Name: First Name: Title:

Address:

City: State: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip:

Phone Number: Email:

Teacher's Name: Teacher's Department:

Do you need to have these volunteer hours verified for credit? Yes No

If so, verification name: Verification email:

Availability

All Day       Morning       Afternoon       Other:

Activity Preference

Set Up / Clean Up    Kids' Activity    Info/Registration   No preference - wherever I'm needed

Photo Release

By submitting this Volunteer Registration, you are granting the Mattie Kelly Environmental Institute employees and agents to take and use visual images of you; including photographs and video recordings.  These images may be used in any manner and you will not be notified of their use by the MKEI.  Your image may be published on web sites, publications, promotions, and advertisements.  By submitting this form you also waive any rights to inspect or approve of the final image, printed or electronic materials that may accompany the image.  You also release MKEI and its employees and agents from any claims or liability that you may encounter in connection with the use of the images.