General Volunteer Interest Form Survey

Contact Info:

1.First Name(Required.)

2.Last Name(Required.)

3.Email(Required.)

4.Phone Number

5.Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Volunteer Info:

6.Have you ever volunteered with Mission MSA?

Yes

No

7.How much time would you like to volunteer annually?

8.Areas of interest? (Examples are including but not limited to)

Fundraising (Example: Host a fundraiser)

Finance (Example: Help form the budget)

Leadership (Example: Board of Directors position)

Advocacy (Example: Write a letter to your elected official)

Awareness (Example: Write a blog or share your MSA story)

Community Engagement (Example: Patient support groups)

MSA Research Development (Example: Grant reviewer)

Patient Education (Example: Curate content for webinars)

Other (please specify)

About you and your MSA connection:

9.Why would you like to volunteer for Mission MSA?

10.What is your connection to MSA?

Other (please specify)

Demographics:

Mission MSA does not discriminate. In an effort to be as accessible and inclusive as possible, it is important for us to understand the diversity of our audience and volunteers. Please tell us about yourself so we can engage all types of people affected by MSA.

11.Please select your age range (OPTIONAL)

12.Please select your gender (OPTIONAL)

13.Please select your ethnicity (OPTIONAL)

14.Please select your community type (OPTIONAL)