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

Registering Yourself as a Volunteer

33% of survey complete.

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

Name: *

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Cell or Daytime Phone Number (we'll use this if we need to call you during the event)

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

Yes

No, but I'll register right now.

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

Yes

Other

Other (please specify)

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* 4. 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)

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* 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.

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

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* 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.

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)

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* 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.

Sign/printing company

Food/beverage company

Promotional items

Audio/visual

Equipment rental (chairs, tables, etc.)

Other (please specify)

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* 8. 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?

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

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* 10. 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

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

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

Question Title

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

Question Title

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

Question Title

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* 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.

Question Title

* 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.

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* 8. What is your affiliation?

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

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

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