Survey - GW_Volunteer - The ALS Association Indiana Chapter

Are you interested in a volunteer opportunity?

Please complete this online interest form and we will contact you shortly.

1.

Preferred Contact Information:

If you have previously registered, please to prepopulate your information.

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

Phone Number:

Employer:

Occupation:

Gender:

Yes, I would like to receive e-mail from The ALS Association Indiana Chapter

Yes, I would like to receive postal mail from The ALS Association Indiana Chapter

Keep me logged in. What's this?

2.

Question - Not Required - Previous Volunteer Experience

3.

Question - Not Required - Indicate which areas interest you:

	Administrative/clerical work
	Computer-data entry/word processing
	Fundraising/special events
	Photography (newsletter, events, Walk to Defeat ALS, etc.)
	Speaker's bureau (daytime hours needed)
	Patient and Family Services Program Support (mailings, copies, events)
	Other

4.

How often are you interested in volunteering?

(Select one of the available choices or enter a different value.)
Question - Not Required -

5.

Question - Not Required - Choose your preferred day(s):

6.

Question - Not Required - Please indicate time of day that is most convenient for you:

7.

Question - Not Required - Briefly state the reasons why you wish to become a volunteer for The ALS Association Golden West Chapter: