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Pink Hands of Hope Volunteer Form
First name
*
Last name
*
Street Address
*
City
*
State
Zip Code
*
Cell Phone
*
Home Phone
Email
*
Date of Birth
*
Month
Month
Day
Year
Shirt Size
Emergency Contact
*
Relationship to Emergency Contact
*
Emergency Contact Phone #
*
Do you volunteer elsewhere?
*
Yes
No
Where/How Long?
ARE YOU A BREAST CANCER SURVIVOR?
*
Yes
No
If yes, year of remission
Do you have any medical limitations?
*
Yes
No
Do you have a Facebook Account?
*
Yes
No
Do you follow us on Facebook?
*
Yes
No
What areas of expertise would you like to share with Pink Hands of Hope? (i.e. crafting, teaching, accounting, office skills, etc.)
Are you interested in b eing on any committee or advisor board? (i.e. Fashion Show, Events, Golf Outing)
Yes
No
Would you be interested in being trained to work in the Support Room to help out cancer patients?
Yes
No
What days work best for you to volunteer? (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time do you prefer? (Check all that apply)
10AM-2PM
2PM-5PM
3PM-7PM
Saturday morning 9AM-12PM
Interested in helping: (Check all that apply)
Weekly
Bi-Weekly
Monthly
Special Events
Please list your last two paid job positions:
Paid Job Position 1
Paid Job Position 1 Duties
Paid Job Position 2
Paid Job Position 2 Duties
I agree to have my name and likeness used on marketing materials such as social media as long as it puts me in a good light and is not detrimental to myself or family.
*
Yes
No
Signature
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