Volunteer Application

Prospective Patroness Application

Introduction/Description

Thank you for your interest in joining NCL!

Please complete the following questions. Completion of this form will create an account for you. Please make note of the user name and password you choose. You will be able to use this account to log in and complete the rest of your application in case you do not complete it at this time.

Please contact VP Membership Anne Gilbert with questions by email at acgilbert@cox.net.

Name

Title

First Name

Middle Name

Last Name

Suffix

Address

Address Type

Country

Street Address

Apt/Suite

City

State

Postal Code

County

Contact Information

Home Phone

Work Phone

Mobile Phone

*One phone number is required

*Please enter a phone number as ###-###-#### or ###-###-####x####

**For international numbers add "+" before the number

Primary Emergency Contact

First Name

Last Name

Relationship

Home Phone

Work Phone

Mobile Phone

Alternate Phone Number

*One phone number is required

*Please enter a phone number as ###-###-#### or ###-###-####x####

Address

Apt/Suite

City

State

Postal Code

Secondary Emergency Contact

First Name

Last Name

Relationship

Home Phone

Work Phone

Mobile Phone

Alternate Phone Number

Address

Apt/Suite

City

State

Postal Code

Statistical Information

Date of Birth (mm-dd-yyyy)

Guardian Username

Guardian password

You are under 13. You will need your parent or guardian to verify your registration.

A guardian must be verified.

Employment Information

Employer

Job Title

Occupation

Create Your Account

New usernames must be at least 6 characters long and can include::
Uppercase letters,
Lowercase letters,
Numbers,
Special characters (Only . @ - _ are supported characters for usernames)

Username

Passwords must be at least 8 characters long and must include:

At least one uppercase letter

At least one lowercase letter

At least one number

At least one special character (The @ symbol is not supported). Special characters cannot be used as the first character for your password.

Password

Verify Password