Survey - Arizona Chapter Volunteer Form - The ALS Association Indiana Chapter

Are you interested in volunteering with The ALS Association?

Please complete the form below 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:

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

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*2.

Question - Required - What is your connection with ALS and/or The ALS Association Arizona Chapter?

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

*3.

Question - Required - Which of these areas interests you? (select all that apply)

	Bite Nite: This event requires formal attire and may include duties such as registration, food runner, or silent/live auction assistance.
	Walk to Defeat ALS: May include duties such as operating food and t-shirt tables, registration, walk route assistance, set-up or tear down.
	Living with ALS Adapted Recreation Program: Includes helping with interactive activities for ALS patients and their families.
	Administrative/Office: Assist in our Phoenix office as needed.

*4.

Question - Required - Which area are you available to volunteer in?

Phoenix

Tucson

5.

Question - Not Required - Do you have any experience, training, skills, or connections (i.e. photography, carpentry, restaurants) that could be beneficial to our Association? If yes, please list those below.

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

6.

Question - Not Required - What is your preferred method of contact?

Phone

Email