Survey - Rhode Island Chapter Volunteer Form - The ALS Association DC/MD/VA Chapter

Are you interested in a volunteer opportunity?

Please complete this online interst 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:

If you respond and have not already registered, you will receive periodic updates and communications from ALS Association - DC / MD / VA Chapter.

Keep me logged in. What's this?

Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	12 to 99 characters
*	Repeat Password: Required

2.

Question - Not Required - Areas of specialized training, skills, talents (i.e. carpentry, photography)?

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

3.

Question - Not Required - Have you had experience working with someone with ALS?

4.

Question - Not Required - Indicate which areas interest you:

	Administrative/clerical work
	Computer-data entry/word processing
	Fundraising/special events
	Other

5.

Question - Not Required - If you indicated other, please describe your interest below:

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

6.

How often are you interested in volunteering?

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

7.

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

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

8.

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

9.

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

Phone

Email

US Postal Service