The ALS Association North Carolina Chapter: Survey - Jim "Catfish" Hunter Detailed Volunteer Form

Jim "Catfish" Hunter Detailed Volunteer Form

Are you interested in a volunteer opportunity?

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

Volunteer Information

Preferred Contact Information:

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

Name:

First Required	Last Required

Email: Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Phone Number:

Employer:

Occupation:

Gender:

Date of Birth:

Month

Day

Year

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

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

Remember me. What's this?

Question - Not Required - Spouse's Name

Question - Not Required - Emergency Contact Name:

Question - Not Required - Emergency Contact Phone Number:

Question - Not Required - Have you ever committed a felony?

Question - Not Required - If yes, please explain:

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

Work/ Volunteer History

Question - Not Required - Education:

Question - Not Required - List Previous Volunteer/Community Services Experience:

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

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

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

10.

Question - Not Required - Physical Limitations:

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

11.

Question - Not Required - Personal References (Two references with phone numbers and no relatives please):

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

12.

Question - Not Required - Date available to begin volunteering:

Month

Day

Year

13.

Question - Not Required - Please indicate the time of day that is most convenient to you:
Please make between 1 and 3 selections from the choices below.

	Morning
	Afternoon
	Evening

14.

Question - Not Required - Choose your preferred day(s). Please check all that apply:

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

Additional Information

15.

Question - Not Required - Are you willing to travel?

16.

Question - Not Required - Why do you want to volunteer with The ALS Association?

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

17.

Question - Not Required - How did you first learn about the ALS Association?

	Website
	Walk
	Family/Friends
	Newsletter
	Media/Advertising
	Personal Connection to ALS

18.

Question - Not Required - If you checked personal connection please explain:

19.

Question - Not Required - Areas of Interest (Check all that apply. See descriptions below.)

	Patient Services
	Advocacy
	Material Distribution
	General Office Needs*
	Media & Awareness
	Walk to Defeat ALS Charlotte
	Walk to Defeat ALS Down East (Greenville area)
	Walk to Defeat ALS Triangle
	Walk to Defeat ALS Greensboro
	Walk to Defeat ALS Winston-Salem
	Walk to Defeat ALS Wilmington
	Walk to Defeat ALS Emerald Isle
	Walk to Defeat ALS Fayetteville
	Other Chapter Events

Areas of Interest Description:
Patient Services: Assist the Patient Services Department with organizing and sending materials to PALS and family members.
Advocacy: Become a Chapter Advocate by helping spread awareness to local and national government officials.
Material Distribution: Help distribute Chapter materials to your local businesses and medical agencies.
Media & Awareness: Create connections between local media outlets (TV, radio, newspapers) and The Catfish Chapter.
General Office Needs: Assist in the Raleigh office with mailings, data entry and walk preparation.
Walk to Defeat ALS: Get involved by forming a team, recruiting teams and sponsors, join the planning committee or volunteering to help on or before Walk Day.
Other Chapter Events: Organize ALS events in your community or assist with other Chapter events such as the Catfish Classic Golf Tournament and the Field of Dreams Gala. Donate auction items.