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AA&MDSIF Walk METRO DC 7/11/10 Volunteer Sign-up

 

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1. Thank you so much for voluntering for this wonderful event!
Please provide us with the following information

Thank you so much for voluntering for this wonderful event! Please provide us with the following information   Name:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Email Address:
Cell or Daytime Phone Number (we'll use this if we need to call you during the event)

2. Have you registered for the walk with your $25 donation through www.FirstGiving.com/aamds?

Have you registered for the walk with your $25 donation through www.FirstGiving.com/aamds?   Yes No, but I'll register right now.

3. Will you be able to volunteer during the walk itself on July 11?

Will you be able to volunteer during the walk itself on July 11?   Yes No Other

Other (please specify)

4. Please let us know which committee(s) you are interested in serving on. Select all that apply.

Please let us know which committee(s) you are interested in serving on. Select all that apply.   Volunteer outreach and coordination Volunteer during the walk Set-up before the walk Clean-up after the walk Outreach to local businesses, especially in Bethesda Outreach to health professionals and clinical centers Outreach to local patients and families Decorations Media/Marketing In-kind donations of refreshments

I can also help in the following way(s)

5. What time(s) are you available to volunteer? Feel free to select as many as you would like. All volunteers will be given the opportunity to walk some portion of the route. If you are available to help with any/all, please check all three choices. You'll receive an email or call confirming your volunteer assignment and time/location for the volunteer briefing.

What time(s) are you available to volunteer? Feel free to select as many as you would like. All volunteers will be given the opportunity to walk some portion of the route. If you are available to help with any/all, please check all three choices. You'll receive an email or call confirming your volunteer assignment and time/location for the volunteer briefing.   ALL-The Entire Event (3pm-10pm): whatever and whenever you need, I'll be there to help! Walk Set-up, Registration and Start (3pm-7pm) Walk Route (5pm-8pm) Walk, Finish Celebration and Clean-Up (5pm-10pm, which includes volunteer briefing, participation in the walk, celebration set-up and clean-up)

Other

6. Do you have special skills? There are a few volunteer assignments that need folks with special skills. If you have any of the following, please let us know. Check any/all that apply.

Do you have special skills? There are a few volunteer assignments that need folks with special skills. If you have any of the following, please let us know. Check any/all that apply.   Photography Strength/Lifting (to move light equipment, tables, chairs, etc.) Medical Professional (doctor, nurse or EMT) Language (are you proficient in a language other than English?) Videography (could you take quality video of the event?) Accounting (are you organized and comfortable when it comes to handling money?) Customer Service(are you comfortable calling on local businesses and groups to ask for help with the walk?)

Other (please specify)

7. Are you able to help with any in-kind donations of goods and services? Do you have connections or know people who can help with donations? Check any/all that apply.

Are you able to help with any in-kind donations of goods and services? Do you have connections or know people who can help with donations? Check any/all that apply.   Sign/printing company Food/beverage company Promotional items Audio/visual Equipment rental (chairs, tables, etc.)

Other (please specify)

8. What is your affiliation?

What is your affiliation?   AA&MDSIF patient, family, friend Local university NIH Medical center or office Community volunteer Facebook group Local high school Civic organization Religious organization Other

Please let us know your group affiliation:

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9. If applicable, What is your relationship to bone marrow failure disease?

If applicable, What is your relationship to bone marrow failure disease?   Patient (under age 18) Patient (18 or older) Spouse Parent of Pediatric Patient Parent of Adult Patient Family Member Friend No relationship, just a caring volunteer

Other

10. OPTIONAL: Are you walking in honor or memory of someone who has battled aplastic anemia, MDS or PNH? Please complete all that apply.

OPTIONAL: Are you walking in honor or memory of someone who has battled aplastic anemia, MDS or PNH? Please complete all that apply.   Yes, I am registered as part of the following team:
Yes, I am walking in MEMORY of the following person(s):
Yes, I am walking in HONOR of the following person(s):
I am a Patient Survivor and am walking in honor of my loved ones! (Y/N)
Please include the following name(s) to the Moment of Remembrance