Survey - Oklahoma Walk Volunteer Form

1.

Please provide your contact information.

*

Name:

Title	First Required	Last Required	Suffix	Professional Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

*

Phone Number: Required

Employer:

Occupation:

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

Email Format:

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 - Required - Birthdate (mm/dd/yyyy)

*3.

Question - Required - Please select your top two choices for volunteer duties. You may select more than two if you choose. Please note the time frames in which these volunteer duties are performed. We will do our best to assign volunteers to their preferred duties.
Please make at least 1 selection from the choices below.

	Set-up (may involve heavy lifting)
	Registration
	Money collection
	T-shirt table
	Floaters
	Water stations
	Trail breakdown & cleanup
	Event breakdown & cleanup (may involve heavy lifting)

4.

Question - Not Required - Please list the first and last names of anyone you want to be grouped with. (We will do our best to assign people with their friends and families, but we cannot guarantee that you will be grouped together.)

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

5.

Question - Not Required - Please list any special conditions or limitations that we should be aware of.

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

6.

Question - Not Required - If you are volunteering as part of a group or organization, please list the name here.

*7.

Question - Required - Please tell us why you are interested in volunteering at the Walk to Defeat ALS.

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