PSPE - Pennsylvania Society of Professional Engineers

75th Anniversary of Engineering Excellence
April 1, 2009
Drexelbrook,
Drexel Hill, PA

Volunteer form
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The Pennsylvania Initiative…
Engineers prepared to serve when disaster strikes.

Volunteer Form

YES! I volunteer to provide Engineering services to help disaster recovery efforts.

Thank you for volunteering! Please understand that your willingness to volunteer does not obligate you to do so. Circumstances may limit your participation. The goal of this program is to identify, recognize and coordinate Engineers who have a willingness to help when needed. Services provided by any volunteer are to be free-of-charge, including any associated expenses.

Direct questions regarding completion of the form or the Pennsylvania initiative to Harve Hnatiuk, P.E. via e-mail (harvehnat@aol.com) or by calling (215) 542-8700, ext. 133.

Contact information:
Name
P.E.?
Home Address
City/State/ZIP
Home Phone
Company Name
Company Address
Company City/State/ZIP
Work Phone
Preferred E-Mail Address
Affiliation(s) (E.G., PSPE, ASCE, IEEE)
Engineering expertise: (eg. Electrical power systems, HVAC, Structural, etc):
Please indicate how you can help during an emergency or its aftermath:	Remote consultations in my area(s) of expertise. Site visits to evaluate situation, determine needs, etc. On-site decision-making assistance in my area of expertise. Media relations (spokesperson to media during emergencies). Other. Please describe:
I am willing to assist in efforts within:	Miles of my home The Commonwealth of Pennsylvania or surrounding regions. Anywhere in the continental United States.
I would consider providing assistance for:	4 hours or less One day Two days One week Two weeks As long as it takes, whatever it takes Other. Please indicate the duration over which you may be able to help:
Additional skills that may be beneficial during disasters:

Your decision to provide assistance to people heavily impacted by a disaster speaks volumes for you as an individual and for the engineering profession. Thank you for stepping forward and making this commitment!

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