Duet Volunteer Application

Thank you for your interest in volunteering with Duet! Please complete the volunteer application below. Generally, this should be completed prior to attending a volunteer orientation. Otherwise, we will reach out to you to discuss the volunteer process in further detail. We look forward to working with you.

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* 1. Title

Mr.

Mrs.

Ms.

Mx.

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* 2. Contact Information

Name

Address Line 1

Address Line 2

City/Town

State/Province

Zip/Postal Code

Home Phone

Mobile Phone

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* 3. Mailing Address (If different than above)

Address Line 1

Address Line 2

City/Town

State/Province

Zip/Postal Code

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* 4. Emergency Contact

Name

Phone Number

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* 5. Date of Birth

Month/Day/Year

Date

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* 6. What is your gender?

Male

Female

Prefer to self-describe:

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* 7. Are you a Veteran?

Yes

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* 8. How did you hear about Duet?

YMCA

Newspaper (Specify Below)

Television (Specify Below)

Radio (Specify Below)

Friend (Specify Below)

Website (Specify Below)

Other (Specify Below)

(Please Specify)

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* 9. Please list three (3) personal references, who are not relatives:

Name:

Telephone number:

Years known:

Name:

Telephone number:

Years known:

Name:

Telephone number:

Years known: