COVID-19 Longhauler Advocacy Project, Inc Volunteer Sign-Up Form.
First, we would like to say thank you so much for your interest and willingness to become a volunteer for the COVID-19 Longhauler Advocacy Project which is a Long COVID Non-Profit whose mission is to advance the understanding of Long COVID and expedite solutions and assistance to Longhaulers and their families through advocacy, education, research, and support. Since June of 2020, we have operated solely on volunteers, all while doing phenomenal work. It is now time to team up with all of you to extend our reach and expand our work.

*Everyone* will need to complete the information below on demographics and interests. That is the general volunteer interest form, but that same information will apply to the sections below it. Completing this form means you will receive emails from us.
Below that, you will find 5 sections, only to be completed if you wish to serve on that team, otherwise, skip!
2) State Advocacy Teams (SAT)
*to be completed by ONLY those interested in being on this team*
3) Special Populations Advocacy Teams (SPAT)
*to be completed by ONLY those interested in being on this team*
4) Community Administrative & Support Team (CAST)
*to be completed by ONLY those interested in being on this team*
5) FB Moderation Team (MT)
*to be completed by ONLY those interested in being on this team*
6) Social Media Affiliate (SMA)
*to be completed by ONLY those interested and meeting the listed criteria*

Each section will have its own description. Please read it carefully to ensure you understand what each role entails. Please ONLY complete the sections for which you wish to sign up for, leaving sections you do not wish to sign up for blank. If you wish to serve *only* as a general volunteer and not on any teams, please stop completing this form when you get to the State Advocacy Team section and continue to click through all the sections until you get to "submit." Please be sure to complete this form even if you have complete any volunteer form in the past. This will be our "all-in-one" form moving forward.

For additional information about us, please visit Longhauler-Advocacy.org. You may contact us at Contact@Longhauler-Advocacy.org
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Email *
Please select which of the following you are. *
Definition: A “longhauler” is someone who has or is still suffering symptoms from a SARS-COVID-19 (COVID) illness at least 90 days from initial infection.
Required
If you are a Longhauler or Caretaker of a Longhauler, please provide the month and year of the initial COVID infection that led to Long COVID below; *
Example; If your date of infection was October 2020, please respond, 10/20.
If you are a medical provider or research please input your field of practice or research and your affiliated medical group, university, etc. *
First  Name *
Last Name *
Email Address *
State of Residency *
Zip Code *
Gender *
Required
Age (parents may register for children who wish to participate in calls to action/ media) *
Race
Clear selection
Employment Status (due to Long COVID) *
Please select all that apply to you *
Required
Are you fluent in any other language besides English, including American Sign Language?                        *Please note if your fluency extends to written language in addition to spoken. *
Please select topics of interest re: Long COVID, especially those that apply to you and you would be willing to speak about in the media/ publicly or be called upon to work on. *
Required
Are there specific conditions you have due to Long COVID you would like to speak about, and can do so comfortably and accurately?
For Example: POTS, Dysautonomia, ME/CFS, MCAS,  Fibromyalgia, etc.
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