Contact Information

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone (XXX) XXX-XXXX*
Emergency Contact Name
Emergency Contact Phone #

Volunteer Information

Why do you want to volunteer?*
Do you have experience with Alzheimer Disease or dementia?
Tell us about any previous volunteer experience you have*
Do you have special training or skills that you would like to share as a volunteer?*
Please select volunteer opportunities that you are interested in*
  • Society Representative
  • Data Entry
  • Learning Series
  • Media
  • Office Assistant
  • Speaker's Bureau
  • Reception
  • Research Event
  • Support Group Facilitator
  • Participate in the Walk for Alzheimer's
  • Participate in Coffee Break
  • Events Manual Assistant
  • Fundraiser Host
  • Material Distribution
  • Other
Other - please describe
What computer programs are you familiar with?*
  • Word
  • Excel
  • Publisher
  • Outlook
  • Other
Other - please describe
What time of day are you available?
  • Mornings
  • Afternoons
Which days of the week are you available on?
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
How many hours are you willing to volunteer?
How did you hear about the Alzheimer Society?
  • Website/Internet
  • Media
  • Materials displayed in community
  • Friend/Family/Colleague
  • At An Event
  • Direct Mail
  • Other
Other - please describe
Language
  • English
  • French
  • Other
Other - please list
Additional Comments

Security Code