Medical Vaccine Volunteer Form First Name *Email *Current Occupation / Profession *No Occupation No Current OccupationLast Name *Checkboxes VaccinatorMedical ConsultBehavioral/Mental Health ConsultMedical ScreenerRequired DocumentsSubmit your Medical License / Certification Number *Upload image of LicenseSubmit numberMedical License / Certification Number *Upload your Medical License / Certificate * Drop your file here or click here to upload Accepted file types are .jpg, .jpeg and .pngSubmit your CPR Certificate Number *Upload image of CertificateSubmit numberCPR Certification Number *Upload your CPR Certificate * Drop your file here or click here to upload Accepted file types are .jpg, .jpeg and .pngInformation for Ulster County IDAddress *Address Line 1Address Line 2CityStateZipPicture of the Front and Back of Your Driver’s License * Drop your files here or click here to upload You can upload up to 2 files. Accepted file types are .jpg, .jpeg and .pngHead shot picture of you (from the neck up) for your ID Badge * Drop your file here or click here to upload Accepted file types are .jpg, .jpeg and .pngDate of Birth *Gender MaleFemaleOtherLast 4 Digits Social Security # *NameSubmit