Volunteer

Name (*First Name, MI, *Last Name)

Home Address

*City

*State

*Zip Code

Phone

Your Email (required)

*How would you like to get involved? (Select all that apply)
 Board Member - the opportunity to participate in the governance of the organization as well as donate or help raise $10,000 per year. Committee Member - the opportunity to help plan the annual gala as well as donate or help raise $1,000 per year. Donor - the opportunity to donate money, products or services to an organization to help it further its mission. Other

*Have you ever done fundraising in the past?
 Yes No
*If yes, how much have you raised? 0-$999$1,000-4,999$5,000-9,999$10,000-49,999

*I am passionate about being involved in (Select all that apply) :
 Infant Mortality Brain Cancer Mental Illness, HIV/AIDS and Homelessness Lyme Disease Sarcoma Melanoma /Skin Cancer Hunger

Current Employment Information

Job Title

Company Name

How did you hear about us?
 Advertisement Referral Search Engine Website Other