Free Clinic
Beacon
House
St. Petersburg Free Clinic        863 3rd Avenue N.        St. Petersburg, FL 33701        Phone 727.821.1200        Fax 727.821.9263
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GET INVOLVED
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VOLUNTEER FORM
Name:
Address:
City/ST/Zip:
Phone:
E-mail:
Please list the day(s) and time you are available to volunteer:
List any licensed/certified professions and areas of specialty:
Please list any additional languages that you speak fluently:
Do you have special skills or areas of interest that you would like to
utilize? If yes, please specify:
Sessions are held the 2nd Tuesday of the month at 10AM and 3rd
Tuesday at 3:30PM.  Please enter the date and time of the orientation
session that you would like to attend:
By submitting this form, I affirm that I have read and agree to the rules
and regulations set forth in the Volunteer Agreement.
Click here to read the Volunteer Agreement.
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