"Oliver" Member/Volunteer Information Form Hope Center Fort Sanders Regional Medical Center 1901 Clinch Ave., 7-North, Knoxville, TN 37916 Phone: (865) 541-3767 Fax: (865) 541-2407 Hope_Center@covhlth.com The Hope Center is devoted to providing supportive services to individuals experiencing a life-threatening illness. Anyone who is affected by HIV-AIDS (or other serious illness) is invited to become a member. You do not have to be HIV positive to be a member. Volunteers are always needed and appreciated.

Date:    Name:    Address:    County:    Phone:  (H)  (W)  Male Female  Ethnicity:    Birthday: / / E-mail: Emergency Contact (optional, to be used only during an emergency): Name:        Relationship:     Contact Phone(s):     Pager:     If you are interested in volunteering, when might you be available? Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday Estimated Time(s) available:     Please check only the service categories that you can support. Special Projects:    Thanksgiving    Christmas    Easter    AIDS Memorial Quilt Displays    Office Projects    Newsletters & Mailings General Supportive Services:    Haircuts - hospital & Home Bound    Gift Certificates (Wal-Mart, Kroger, etc)    Fundraising Events    Educational Programs & Workshops    Home Assistance, Telephone Support and Care Teams (Training is Required) (All Hope Center services are offered at no charge to the patients or their families.) Would you like to be contacted by the Hope Center to receive information about HIV support services?  Yes Please include your questions, special needs, concerns, or comments below:

Covenant Health | All About Us
Fort Sanders Regional Medical Center

Notice Of Privacy Practices | Disclaimer