Exit this survey 

AA&MDSIF Walk AUSTIN 4/18/10 Volunteer Sign-up

 

*

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

2. 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 (12-5): whatever and whenever you need, I'll be there to help! Walk Set-up, Registration and Start (12pm-2pm) Walk Route (2pm-4pm) Walk Finish Celebration and Clean-Up (3pm-5pm)

Other

3. 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.   Strength/Lifting(to move light equipment between the start and finish) 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

Other (please specify)

4. What is your affiliation?

What is your affiliation?   AA&MDSIF patient, family, friend University of Texas Other university Community volunteer Facebook group Local National Honor Society

If Facebook or Community Volunteer, please let us know how your group affiliation learned about this event:

*

5. 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

6. 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.

7. 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)