ABOUT YOU:

Your name:

Your address:

Tel (day):

Tel (eve):

Mobile No:

Email:

Date of Birth:

Are you a member of a wildlife trust?
Yes (Montgomeryshire)    Yes (other)    No 

Please list below any allergies or medial conditions the Trust should be aware of:

Doctor's name:

Tel:

Who can we contact in case of an emergency?

Contact name:

Tel:

AVAILABILITY:
 
Do you have available transport? yesno
Would you be prepared to travel to the Trust office in Welshpool? yesno
Would you be prepared to travel elsewhere in the country? yesno

How often are you prepared to volunteer? Regular basis (i.e. Once a week/month)Casual Basis (i.e. When tasks arise)

TASK PREFERENCES / SUITABILITY
 
What type of volunteer tasks would you like to be involved with?
 
Practical Reserve Management
Survey Work
Fundraising
Membership and Volunteer Recruitment
Administration (Office based work)
Magazine Packing
Helping to run events
Translation work (English - Welsh)
Working with young people
Other
 
Please note a Criminal Record Bureau check will be required wherever work with children is involved.

Please list below any skills or abilities you possess which you feel could be beneficial to the Trust (e.g. Word Processing, land management, teaching experience etc)



 
Please list below any qualifications you hold which may be beneficial to the Trust (e.g. Chainsaw certificate, first aid, relevant degree / diploma)



 
Do you have any special environmental/natural history interests?


 
If you are under the age of 18 please print this page and sign in the space below:
 
Signed:_________________________ Date:_______________________
 
Parent/Guardian Signature (if under 18):___________________________
 
(This information will be stored and used in accordance with the Data Protection Act, and will not be passed on to any third parties. A copy of our Data Protection Policy is available on request)
 
Please return this form to: Eley Hart (Administrative Officer)
Montgomeryshire Wildlife Trust
20 Collot House, Severn Street, Welshpool, Powys, SY21 7AD
Tel: 01938 555654
Fax: 01938 556161
email: montwt@cix.co.uk