Secured Register for Access Page




Not a Member? Click here to register Forgot Password

To become a Lorain County MRC Volunteer, please fill out the information below. You must also register on the Ohio MRC website to ensure that you are recognized by the state as an MRC volunteer and allow for enhanced liability coverage during a disaster. You are not required to provide volunteer services outside of Lorain County; however, you can choose to assist within your county, region, state, and/or nation on the Ohio MRC application. The Ohio MRC volunteer application takes approximately 5-10 minutes to complete.

If you do not register on the Ohio MRC website on your own, the Lorain County MRC coordinator will add your information provided on this registration to the Ohio MRC website. By filling out this registration form, you give the MRC Coordinator permission to add your information to the Ohio MRC website.

First Name:

Last Name:

Address:

City, State Zip:

Telephone:

Date of Birth:

Drivers License Number:

Drivers License State:

Drivers License
Expiration Date:

Credentials,
Licenses, etc:

Health Department:

Category:

Sub-Category:

Are you willing to volunteer in the event of a disaster?

Yes No

In the event of a disaster, certain sites throughout the county are designated as emergency clinics known as PODs or Points of Dispensing. These PODs will be staffed by both health district staff members and volunteers.
Do you wish to be associated with a POD location?

Yes No

Please designate up to three POD locations that you are willing to assist in.

First Choice:

Second Choice:

Third Choice:

Email Address:

Your email address will be your login. If you do not
have an email address, check the box below.
I do not have an Email Address

Password:

I understand that by clicking "Yes", I hereby certify and affirm all the information I have provided is true and accurate to the best of my knowledge. I acknowledge that my information will be added to the Ohio Medical Reserve Corps volunteer registration by the Lorain County Medical Reserve Corps Coordinator if I have not already done so. I also acknowledge that Lorain County Medical Reserve Corps/Ohio Citizen Corps/Ohio Medical Reserve Corps may verify the information.

Yes

Register as an MRC Volunteer