Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Phone *

(###)

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Work Phone

(###)

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During which hours are you available for volunteer assignments? *

(Multiple may be choosen)

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

Tell us in which areas you are interested in volunteering *

(Multiple may be choosen)

Administration

Events

Social Media

Fundraising

Pick-Up and Deliveries

Phone bank

Newsletter production

Volunteer coordination

Agreement and Signature *

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, my commitment is for 3 years and any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

First Name

Last Name

Date *

MM

DD

YYYY

Contact in Case of Emergency

(###)

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