Survey - Georgia Walk Volunteer Survey - The ALS Association Georgia Chapter

The ALS Association Georgia Chapter

Please enter your contact information below:

Name:

Title	First Required	Middle Required	Last Required	Suffix

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association Indiana Chapter.

Question - Not Required - How should we contact you?

Phone

Question - Not Required - At which Walk location would you like to volunteer?

Question - Not Required - How would you like to help?
Please make up to 3 selections from the choices below.

	Pre-Walk Volunteer in the office Monday-Friday from 9am-5pm
	Walk Day Volunteer
	Post-Walk Volunteer in the office Monday-Friday from 9am-5pm

Question - Not Required - If you are interested in becoming a Walk Day Volunteer, please indicate your area of interest:

Question - Not Required - Are you over the age of 16?

	Yes
	No

Question - Not Required - Do you know someone with ALS?

(Maximum response 255 chars, approx. 5 rows of text)

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The ALS Association Georgia Chapter
(404) 636-9909 or (888) 636-9940
5881 Glenridge Dr - Suite 200 - Atlanta, GA 30328