CRIS Radio Volunteer Application

Name

First NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Other Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address
example@example.com
Work E-Mail Address
example@example.com
In Case of Emergency
Contact Name

First NameLast Name
Relationship
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Availability
Please list the day(s) and time(s) you are available:
Some grant funding sources require CRIS to report information about volunteer age, race and disability status. This information is not used for any other purposes. Your cooperation is requested but not required for volunteer service.
Ethnicity
Date of Birth

MonthDayYear

Talent Release & Statement of Confidentiality
Talent Release

I grant authority to Connecticut Radio Information System, Inc., and those acting within its authority, to distribute via radio, television, telephone, and the internet my name and all live or recorded readings and/or performances submitted by me. Authority is also granted to record and copy my submitted readings and/or performances to audiotape, cd, or any other medium, for distribution to individuals or groups as Connecticut Radio Information System, and those acting within its authority, deem appropriate.
Signature of Volunteer
Signature of Parent/ Guardian (under 18)
Statement of Confidentiality

I promise to respect the privacy and confidentiality of all listeners of CRIS.
Signature of Volunteer
Please verify that you are human
Should be Empty:

In Case of Emergency