Volunteer Application – Rail Safety Alliance

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Name*

First Last

Location*

City State / Province / Region ZIP / Postal Code

Primary Phone*

Type*

Email*

Have you ever been convicted of a felony? (If yes, you may still be eligible to become a Presenter.)*

Yes

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I would like to volunteer in the following state(s)

Idaho

Nevada

Utah

I would like to volunteer in the following state*

Idaho

Nevada

Utah

Affiliation*

Organization*

How did you hear about National Rail Safety Alliance?*

How do you feel about speaking before groups?*

Why do you want to volunteer with National Rail Safety Alliance?*

Please read before signing.

I understand and agree to abide by the policies of National Rail Safety Alliance, Inc. (NRSA) and those of the state in which I wish to volunteer, and to use only materials approved by NRSA in my volunteer work, presentations, etc. I hereby affirm that the information provided by me on this application is complete and accurate. I understand that any falsification or omission will be grounds for immediate removal from my volunteer work with NRSA. Should NRSA determine that an investigation of my background be advisable and warranted, I hereby authorize NRSA to obtain data regarding information provided on this application and my background in general, including but not limited to any charges and/or convictions I may have had for violation of municipal, county, state or federal laws since reaching the age of majority (legal age). This information may be gathered from any source, including any law enforcement agency of state or federal government, or from third-party providers of information originally obtained from law enforcement or court records. NRSA reserves the right, in its sole discretion, not to accept an individual or to suspend or terminate any individual from participation as a NRSA volunteer from the NRSA program. Suspension or termination may be made for any reason, including but not limited to violation of NRSA policy, and/or any other reason based on the needs and best interests of NRSA. View full policies and procedures here.

Applicant's signature*

Application Date*