Volunteer Engagement Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. What is your date of birth? MM/DD/YEAR Date Question Title * 4. What is your relationship to MS? Child of Someone with MS Coworker of Someone with MS Friend of Someone with MS I have MS No Connection Relative Other Sibling of Someone with MS Spouse of Someone with MS Question Title * 5. What is your address? Street City State Zip Question Title * 6. Home (Primary) Email Question Title * 7. Business (Secondary) Email Question Title * 8. Home (Primary) Phone Question Title * 9. Cell (Secondary) Phone Question Title * 10. Business Phone Question Title * 11. Preferred Method of Contact Phone Email Either Phone or Email Question Title * 12. What volunteer opportunities are you most interested in? Ambassador Program Bike MS Data Entry Do It Yourself Fundraising Event Planning Front Desk Hike MS Mailings Medical at Events Peer Support Phone Calls Photography at Events Self Help Group Leader Support Services Walk MS Other (please specify) Question Title * 13. Employment Information Employed Unemployed Retired Student Question Title * 14. What kind of time commitment are you looking for? One Time Ongoing Other (please specify) Question Title * 15. Are there any physical limitations we should be aware of? Question Title * 16. Do you have any specific skills you would like us to be aware of? Question Title * 17. If employed, does your business encourage volunteer hours and/or offer matching gift dollars for hours volunteered? Yes No I don't know NA Question Title * 18. If a student, can you receive credit hours for your volunteer hours? Yes No I don't know NA Question Title * 19. Are you aware of the Programs and Services available for those with MS and their caregivers? Yes No Question Title * 20. Would you like a representative of the Society to contact you about the programs and services available? Yes No Next