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ECMRC Application

The Erie County Medical Reserve Corps (ECMRC) is a collaboration of students, faculty, community members and professionals from various healthcare and emergency organizations and businesses.

ECMRC aims to increase the health and preparedness of the Erie County community by training and maintaining a group of ready volunteers to respond to public health disasters and crises.

To join ECMRC, please complete and submit this form.

If you prefer, you can complete and mail this printable application.   If you have any questions, please contact us at 716-858-7101.

Name
Address
Emergency contact name
Type of volunteer
Type of medical volunteer
Are you a student?
Are you a retiree