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

Registering Yourself as a Volunteer

33% of survey complete.

Question Title

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

Question Title

* 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.

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

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* 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.

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)

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* 4. 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:

Question Title

* 5. 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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* 6. 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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* 7. 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)

Question Title

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

Question Title

Question Title

* 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.

Question Title

* 4. What is your affiliation?

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

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

Question Title

* 7. 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