Volunteer Participation Form

We need to know when you are educating others on the importance of organ, tissue and eye donation.  Please fill out the form below every time you do a presentation, work an event, help in one of the IOPO offices, etc.  It is IMPORTANT that IOPO is able to keep track of the number of people reached throughout the state of Indiana.

Name: First: Last
Name of Group/Event:
Date of Event (mm/dd/yy)
Time of Event
Where event took place (city)
Attendance: Adults: Students:
Number of Presentations
Amount of time devoted to this event
(This includes preparation and travel time)
Mileage Roundtrip
Yes, I would like IOPO to provide the $0.505 per mile reimbursement

No, I do not want the offered reimbursement
Comments

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