New Volunteer Survey

Contact Information and Availability

Thank you for your interest in volunteering with Chemo Comfort. We encourage you to view our website at www.chemocomfort.org so that you understand our mission and Chemo Comfort kits. Please fill out all of the information below so that we have a clear idea about the experience you are looking for and the time that you are able to give.

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* 1. Please enter the date.

Today's Date

Date

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* 2. Please provide the following contact information:

Name

Address (Number and Street)

Address (City, State, and Zip)

E-Mail Address

Phone Number(s)

Date of Birth

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* 3. If you have a car, would you be willing to use it to help transport materials to events or deliver kits to partner organizations?

Yes

N/A

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* 4. How did you hear about Chemo Comfort?

Brochure

chemocomfort.org

Event

Friend or Family Member

Google

idealist.org

Meet-up group

Other Website

Other (please specify)