Breast Cancer Can Stick It! Volunteer Application
Please fill out the following application as completely as you can.
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Full Name (including middle and maiden names) *
Date of Birth *
Contact Phone Number *
Contact E-mail Address *
Street Address *
City, State, Zip *
Facebook URL, Instagram username, Twitter handle, etc. (We will add you to our Facebook volunteer group page where we post volunteer opportunities and news.)
What is your availability like? (eg, weekends only, weekday mornings, evenings, etc.)
Tell us which areas you're interested in helping in: *
Do you have any skills or experience you feel might be beneficial?
Do you have any hobbies or other information about yourself that you wish to share with us?
Have you ever been convicted of a violation of law, other than a minor traffic violation? *
If yes, please explain the nature of the crime and the date of the conviction and disposition:
Emergency Contact: Name, Relation, and phone number(s) *
By submitting this application, I agree to the Rule of Conduct at , and I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.Please be aware that our organization routinely performs criminal background checks via information provided through Public Data.It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.Thank you for completing this application form and for your interest in volunteering with us.By typing your name, you are providing your electronic signature stating you understand the above information *
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