Survey - Greater New York Walk Volunteer - The ALS Association Indiana Chapter

1.

Please enter your contact information below:


	Title:
*	First Name: Required
	Middle Name:
*	Last Name: Required
	Suffix:
*	Email: Required
	Street 1:
	Street 2:
	City:
	State / Province:
	ZIP:
*	Phone Number: Required
	Yes, I would like to receive e-mail from The ALS Association Indiana Chapter

*2.

Question - Required - At which Walk location(s) would you like to volunteer?
Please make between 1 and 6 selections from the choices below.

	New York City Walk to Defeat ALS
	Jersey Shore Walk to Defeat ALS
	North Jersey Walk to Defeat ALS
	Westchester Walk to Defeat ALS
	Long Island Walk to Defeat ALS
	Hudson Valley Walk to Defeat ALS

*3.

Question - Required - How would you like to help? *Please note times are approximate and can be adjusted to fit your schedule*

	Event Setup (8:00 AM - 11:00 AM)
	Assistance During the Walk (10:00 AM - 1:00 PM)
	All Day Volunteer (8:00 AM - 1:00 PM)

*4.

Question - Required - In addition to volunteering, do you plan on walking at the Walk? *If you plan on walking, the volunteer time slot is limited to 8:00AM-11:00AM

*5.

Question - Required - If you are interested in becoming a Walk Day Volunteer, please indicate your area of interest:
Please make between 1 and 7 selections from the choices below.

	Registration *ages over 18 only
	Walk Route Marshals
	Water Station
	Food Tent *ages over 18 only
	T-Shirts
	Advocacy
	Parking Marshal *ages over 18 only
	Unlock ALS

*6.

Question - Required - Are you above 18 years old?

*7.

Question - Required - Waiver: I hereby waive all claims against The ALS Association, sponsors or personnel for any injury that I or my child may suffer from participation in this event. I grant full permission for organizers to use photographs, videotapes, motion pictures, recordings or any other record of this event in which I may appear for any legitimate reason.
Please make 1 selection from the choices below.

I agree

8.

Question - Not Required - How did you hear about our Walk Volunteer opportunities?

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

Please contact us at 212-619-1400 if you have not received any communication one week before the Walk.