Click here to download the pdf version of this form. CORI Update * Full Name * Address * Phone * Email Address * Are you a member of COA? * Yes No If not, then we need your emergency contacts: Contact 1 (name & phone) If not, then we need your emergency contacts: Contact 2 (name & phone) Areas of Interest (check all that apply) * Administrative Assistance/ miscellaneous/ special projects Aide on bus for Sight Loss Group Aide on COA van bi-monthly to assist in delivering Government food/ Family Pantry Computer course instructor Desk receptionist Friendly Visitor Greeter Kitchen aide for Sr. Dining Program Medical Driver for rides to Doctor appointment’s Minibus driver Newsletter labeling Proofread newsletter Public relations assistance REACH Reading Current Events to vision impaired Reading newsletter on audio tape for vision impaired Telephone Reassurance Caller Travel Assistant TRIAD house numbering Leave this field blank
