2016 Purple Bra Day Volunteer Registration Form

Purple Bra Day will be held on Friday 17 June, 2016.

Purple Bra Day raises funds for Breast Cancer Care WA which provides emotional, practical and financial assistance to people in WA with breast cancer.

Congratulations on signing up to volunteer and help make 2016 the most successful Purple Bra Day yet!

We have a huge variety of opportunities available to help make this day a success so chose 1,2 or several options to join all the fun!

Don't forget that we encourage dressing up as well as donning our famous purple bra (or a purple mask if you prefer), and being involved is a great way to gain events experience, meet new people, make new friends and, most of all, know you are making a positive difference and helping raised funds and awareness for Breast Cancer Care WA!

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* 1. Type of registration?

Individual

Group/Work Place

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* 2. Please provide the following details;

Title:

First Name:

Surname:

Company name: (if work place registration)

Address:

Suburb

Post Code:

Phone number:

Mobile:

Email:

Number of participants:

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* 3. How did you hear about Purple Bra Day?

I'm on the Breast Cancer Care WA mailing list

Local paper

Friend

I am an existing volunteer at Breast Cancer Care WA

Radio

The West Australian

Volunteer Newsletter

Facebook

Other (please specify)

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* 4. How would you like to be involved this Purple Bra Day?

PBD Pack Assembling & admin tasks BCCWA office in Cottesloe - Weekdays until Thursday 16 June

Tin shaking/collecting donations at PBD Street Appeal, Perth CBD - Friday 17 June

Tin shaking/collecting donations at PBD Street Appeal, train station of choice - Friday 17 June

If train station (or other location) your local area is selected, please specify choice of location

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* 5. FRIDAY 17 JUNE - We need as many of you as possible, for as long as possible, from 6.30am, and have various shifts throughout the day! We will wrap up by around 5.00pm, so please indicate below your availability.

	Morning	Lunch break	Afternoon	All day/any shift
Perth CBD	Perth CBD Morning	Perth CBD Lunch break	Perth CBD Afternoon	Perth CBD All day/any shift

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* 6. If you can you help us by creating hero packs to send to our Purple Bra Day participants? If you ticked yes to assembling PBD packs, please indicate below what days or dates you are available.

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* 1. Type of registration?

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* 2. Please provide the following details;

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* 3. How did you hear about Purple Bra Day?

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* 4. How would you like to be involved this Purple Bra Day?

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* 5. FRIDAY 17 JUNE - We need as many of you as possible, for as long as possible, from 6.30am, and have various shifts throughout the day! We will wrap up by around 5.00pm, so please indicate below your availability.

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* 6. If you can you help us by creating hero packs to send to our Purple Bra Day participants? If you ticked yes to assembling PBD packs, please indicate below what days or dates you are available.

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* 7. Do you have any friends who would like to join you? If yes, please write their names and emails below or please encourage them to register online